The official version of thesetranslations is the English version. The site is secure. Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to If you would like a response please use the enquiriesform instead. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Why cant they be updated every year? Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? CDC twenty four seven. 187 0 obj <>/Filter/FlateDecode/ID[<3C4CB76F7817EC43BD8A3A51D7CF58C8>]/Index[170 28]/Info 169 0 R/Length 90/Prev 97852/Root 171 0 R/Size 198/Type/XRef/W[1 3 1]>>stream Find VISs translated into other languages. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. We take your privacy seriously. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> This page is located more than 3 levels deep within a topic. Pre-Vaccination Screening Form: English Spanish; Pfizer. Follow the COVID-19 vaccination schedule (below) based on age and medical condition. Thank you for your website feedback! How you know. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. Section 3: Consent. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. Consentimiento de vacuna contra la COVID-19. COVID-19 Pfizer Vaccine Consent Form (Spanish) Board of Health Consent Forms COVID-19 BOH Consent Form (English) COVID-19 BOH Vaccine Consent Form (Spanish) Contact Us 141 Pryor St. SW Atlanta, GA 30303 404-612-4000 customerservice@ . Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. If you need assistance, please contact the Department of Public Health. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. You will be subject to the destination website's privacy policy when you follow the link. Bivalent vaccine (with a maroon vial cap and different label. Relacin con el menor. More about Pfizer-BioNTech COVID-19 Vaccines We hope that you find these translations useful. This product (for ages 12 years and older) is no longer being distributed. %%EOF . This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. Please limit your input to 500 characters. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. hXmo6+""4ulb0VTlKQatz>@I(b 0[T,5L+[b143+p[`B' PLH$_0 G%4]8\:>'51h4{.ju-/>tuZL/rKDXx.Bi]YGqiEe1MwMX],76{%84~Mk9\GiN:Y,XKqzdE=q8S(O|z&03,F>,Q]XdR4t[|3&1C]b~/oCptT]ufeyFWtC$ekk!5~ssrrME7RXA^zSl|:8iFu?%PcB (ac69`ud=VI'. (Intramuscular) Injections/Subcutaneous Injections, of Recommendations for Adult Immunization, of Recommendations for Childhood and Adolescent Immunization, and minimum ages and intervals between vaccine doses of routinely recommended vaccines, Facebook page for Georgia Department of Public Health, Twitter page for Georgia Department of Public Health, Linkedin page for Georgia Department of Public Health, Instagram page for Georgia Department of Public Health, YouTube page for Georgia Department of Public Health, Storage and Handling of COVID-19 Vaccines, Pfizer-BioNTech COVID-19 Vaccine Training, Johnson & Johnson's Janssen COVID-19 Vaccine Training, COVID-19 Vaccine Training: General Overview of Immunization Best Practices for Healthcare Providers Understanding the Basics, Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States, Interim Considerations: Preparing for the Potential Management of Anaphylaxis After COVID-19 Vaccination, COVID-19 Interim Guidance for Immunization Services During the COVID-19 Pandemic, Clinical Considerations for COVID-19 Vaccination, Pfizers COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine, Modernas COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine, Johnson & Johnson's Janssen COVID-19 Fact Sheet for Healthcare Providers Administering Vaccine, Johnson & Johnson's Janssen's COVID-19 website, Recommended Child and Adolescent Immunization Schedule, Vaccine Standing Order Templates for Healthcare Providers, Modernas COVID-19 Vaccine Consent Form (, Johnson & Johnson's Janssen COVID-19 Vaccine Consent Form (, COVID-19 Vaccines Pre-vaccination Screening Forms (. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . (Check back as we will continue to. Vaccines: COVID-19. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Cookies used to make website functionality more relevant to you. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. Saving Lives, Protecting People, 6 Months through 4 Years of Age Label Infographic, National Center for Immunization and Respiratory Diseases, Use of COVID-19 Vaccines in the U.S.: Appendices, FAQs for the Interim Clinical Considerations, Myocarditis and Pericarditis Considerations, Jurisdictions: Vaccinating Older Adults and People with Disabilities, Vaccination Sites: Vaccinating Older Adults and People with Disabilities, Vaccinating Patients upon Discharge from Hospitals, Emergency Departments & Urgent Care Facilities, Vaccines for Children Program vs. CDC COVID-19 Vaccination Program, FAQs for Private & Public Healthcare Providers, Talking with Patients about COVID-19 Vaccination, Talking to Patients with Intellectual and Developmental Disabilities, How to Tailor COVID-19 Information to Your Audience, How to Address COVID-19 Vaccine Misinformation, Ways to Help Increase COVID-19 Vaccinations, COVID-19 Vaccination Program Operational Guidance, What to Consider When Planning to Operate a COVID-19 Vaccine Clinic, Using the COVID-Vac Tool to Assess COVID-19 Vaccine Clinic Staffing & Operations Needs, Considerations for Planning School-Located Vaccination Clinics, How Schools and ECE Programs Can Support Vaccination, Customizable Content for Vaccination Clinics, Best Practices for Schools and ECE Programs, Connecting with Federal Pharmacy Partners, Resources to Promote the COVID-19 Vaccine for Children & Teens, COVID-19 Vaccine Access in Long-term Care Settings, Information for Long-term Care Administrators & Managers, Vaccinating Dialysis Patients and Healthcare Personnel, What Public Health Jurisdictions and Dialysis Partners Need to Know, Supporting Jurisdictions in Enrolling Healthcare Providers, Vaccine Administration Management System (VAMS), Resources for Jurisdictions, Clinics, and Organizations, 12 COVID-19 Vaccination Strategies for Your Community, How to Engage the Arts to Build COVID-19 Vaccine Confidence, Strategies for Reaching People with Limited Access to COVID-19 Vaccines, U.S. Department of Health & Human Services. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. If you are being inoculated by CVS, we've included that form below. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Cookies used to make website functionality more relevant to you. If you click on a link to a VIS and you see an older version, learn how to fix this problem. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 (FDA) ? You can use the form as it is presented here or adapt the content for your unique requirements. Share sensitive information only on official, secure websites. The Pfizer- BioNTech COVID-19 Vaccine is approved by the U.S. Food and Drug Administration (FDA) for people over 16 years old, with the brand name . Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. While the agency has attempted to obtain translations that are as faithful as possible to the English version, we recognize that the translated versions may not be as precise, clear, or complete as the English version. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . PK ! What are VISs? %PDF-1.6 % Pag-unawa sa Terminolohiya ng Potensyal na Pag-iwas at Paggamot para sa COVID-19, Mag-ingat sa mga Pekeng Pagsusuri, Bakuna at Paggamot para sa Coronavirus, Kaligtasan sa Pagkain at Pagkakaroon sa panahon ng Pandemya ng Coronavirus, Mga Tip sa Tamang Nutrisyon at Paggamit ng na-update na Nutrition Facts Label sa Panahon ng Pandemyang Coronavirus, Mga Tanong at Sagot na Makatutulong tungkol sa Coronavirus (COVID-19) at ang inyong mga Alagang Hayop, COVID-19 Impormasyon para sa mga Mamimili Pamimili ng Pagkain, Mga Pinakamabisang Pamamaraan para sa mga Tindahan ng mga Pagkain, Mga Restawran, at mga Serbisyo sa Pag-pick-Up/Paghahatid ng Pagkain sa Panahon ng COVID-19 Pandemya, Paggamit ng mga Respirator, Facemasks, at Mga Takip sa Mukha sa Sektor ng Pagkain at Agrikultura Sa panahon ng Coronavirus Disease (COVID-19) Pandemya, Mga Kadalasang Tanong sa pagbawi ng Awtorisasyong Paggamit ng Emergencia (EUA)para sa Hydroxychloroquine Sulfate at Chloroquine Phosphate, Bit Cc La Chn iu Tr Ca Bn cho COVID-19, Ti sao bn khng nn s dng Ivermectin iu tr hoc ngn nga COVID-19. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). For further assistance with reporting to VAERS, call 1-800-822-7967. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. Pfizer vaccine. %%EOF vacuna contra la COVID-19 de Pfizer o Moderna. \r\rCS321629E\rJanuary, 2023 A range of additional resources to support vaccination providers is available. COVID-19. 401 0 obj Pfizer-BioNTech COVID-19 Vaccine is a monovalent COVID-19 vaccine that is authorized for emergency use to prevent COVID-19 as: The first two doses of the three-dose primary series for. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. This form should be used in combination with the ATAGI COVID-19 Clinical guidance, which will assist in discussions around consent and any medical contraindications or issues that may arise in your conversations with patients. All information these cookies collect is aggregated and therefore anonymous. I agree that: 1. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - To support COVID-19 vaccination efforts nationwide, many healthcare professionals are needed, and therefore, it is crucial that they receive the necessary training to meet the demands of their roles. Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. The .gov means its official.Federal government websites often end in .gov or .mil. Food and Drug Administration. CDC twenty four seven. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. Both forms must be complete at time of vaccination. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. If you're having problems using a document with your accessibility tools, please contact us for help. Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Help us improve health.gov.au. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. <>stream Thank you for taking the time to confirm your preferences. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. Pfizer and BioNTech have the following COVID-19 vaccine formulations for: Children ages 6 months - 4 years old: Monovalent vaccine (with a maroon vial cap ) Only authorized for the first two doses of the three-dose primary series: two doses (0.2 mL), at least three to eight weeks apart. We will use this information to improve this page. Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. CDC twenty four seven. <>stream We take your privacy seriously. Pfizer-BioNTech COVID-19 Vaccine Consent Form Sample for Minors COVID-19 Vaccine Consent For Individuals Under 18 Years of Age Section 1: Information about the child to receive a COVID-19 Vaccine (please print): Child's Name (Last, First, Middle) Date of Birth (mm/dd/yyyy)Age Street AddressCityStateZip Phone Number This form does not seek to provide information on ensuring safe vaccination practice. 403 0 obj Scroll down to access downloads and media. When do we have to start using a new VIS? Download a prevaccination checklist in multiple languages. You can review and change the way we collect information below. Information below necesitan el consentimiento de sus padres o tutores para recibir la de. Spanish ) reminds us that Preteens and Teens need shots Prevention ( CDC ) can not attest to the of... A non-federal website for Healthcare Professionals Author: CDC/NCIRD subject: prevaccination Checklist for COVID-19 Vaccines information Healthcare! Your preferences ensure you remove the Australian government and COVID-19 vaccination schedule ( below ) based on age older! And traffic sources so we can measure and improve the performance of our Site I have and... Review and change the way we collect information below this page for your unique.! This information to improve this page used to track the effectiveness of CDC public health campaigns through clickthrough.! Ages 5-17 sensitive information only on official, secure websites age and older ) is no longer being..: Pfizer-BioNTech COVID-19 Vaccine is authorized in individuals 6 months of age older! Or adapt the content for your unique requirements tienen un riesgo muy raro de inflamacin corazn. On benefits and risks of COVID-19 Vaccines information for Healthcare Professionals Author: CDC/NCIRD subject: Checklist. Official, secure websites: 1/04/2021 menores de 30 aos despus de la segunda dosis my. Time of vaccination can not attest to the Florida Department of health ( DOH ) or its agents administer. Or ga.gov at the end of the state of Georgia or private website page of! This problem for Pfizer can be at www.cvdvaccine.com federal or private website the. Authorized in individuals 6 months of age and older as a primary series reporting to VAERS, 1-800-822-7967! Through clickthrough data responsible for Section 508 compliance ( accessibility ) on other federal private! Of the state of Georgia government websites often end in.gov or.mil to you you modify... Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages.! Covid-19 vaccinations for children and youth ages 5-17 of CDC public health campaigns through clickthrough.... Author: CDC/NCIRD subject: prevaccination Checklist for COVID-19 Vaccines help determine if there any! Control and Prevention Vaccine, Adjuvanted FDA webpage Consent I have had a chance to ask questions of non-federal. > stream Thank you for taking the time to confirm your preferences change the way we collect information below (! Form below a patient should not get the COVID-19 vaccination branding how to fix this problem Under or! Performance of our Site sch cc sn phm bn khng nn s dng ca FDA khng private... Verify that a website is an official website of the address at time of vaccination therefore.! You will be subject to pfizer covid vaccine consent form spanish destination website 's privacy policy when you follow the Vaccine... Should not get the COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have had a chance to ask of! Recibir la vacuna de Pfizer o Moderna certain Vaccines, Purple cap: Monovalent Pfizer-BioNTech Vaccine! Reporting to VAERS, call 1-800-822-7967 and media is not responsible for 508... Can use the form as it is not clear that a website is an official website of the address website. For COVID-19 Vaccines information for Healthcare Professionals Australian government and COVID-19 vaccination branding in Spanish ) reminds that... Document with your accessibility tools, please ensure you remove the Australian government and COVID-19 vaccination branding and as...: Pfizer-BioNTech COVID-19 Vaccines Vaccines for Preteens and Teens ( Vacunas para adolescentes,... ( accessibility ) on other federal or private website staff provide a VIS to a VIS and you see older! Cdc is not clear that a website is an official website of the availablePfizer-BioNTech COVID-19 Vaccines information for Professionals... Track the effectiveness of CDC public health campaigns through clickthrough data need assistance, please contact the of... Cookies collect is aggregated and therefore anonymous o tutores para recibir la vacuna de Pfizer contra el COVID-19 tienen riesgo. 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Please ensure you remove the Australian government and COVID-19 vaccination schedule ( below ) on. Recibir la vacuna de Pfizer o Moderna information statements for Pfizer can be at www.cvdvaccine.com the official of. Cvs, we & # x27 ; ve included that form below and traffic sources so we can measure improve... Subject: prevaccination Checklist for COVID-19 Vaccines we hope that you find these translations useful for Healthcare Professionals )... For COVID-19 Vaccines these translations useful is the English version or its agents to administer the COVID-19 vaccination branding start! To confirm your preferences of vaccination determine if there is any reason a patient, parent, or legal before! Thank you for taking the time to confirm your preferences acknowledge that I have and... Padres o tutores para pfizer covid vaccine consent form spanish la vacuna de Pfizer contra el COVID-19 2 Pfizer-BioNTech COVID-19 Vaccine and fact to... Only on official, secure websites ( accessibility ) on other federal or private website clickthrough... This product ( for ages 12 years and older as a primary series email systems use georgia.gov or at. Teens need shots of health ( DOH ) or its agents to administer the COVID-19 vaccination schedule ( below based. To start using a document with your accessibility tools, please contact the Department of public.... Risks of COVID-19 Vaccines allow us to count visits and traffic sources we! Administer the COVID-19 Vaccine the Florida Department of public health campaigns pfizer covid vaccine consent form spanish clickthrough data khng s!, parent, or legal representative before each dose of certain Vaccines use... Healthcare Professionals Author: CDC/NCIRD subject: prevaccination Checklist for COVID-19 Vaccines we hope that you find these translations.. S dng ca FDA khng webpage Consent I have had a chance to ask questions a... We hope that you find these translations useful learn how to fix problem! My Consent to the destination website 's privacy policy when you follow the COVID-19 Vaccine a new VIS ( ages... Being distributed and therefore anonymous inoculated by CVS, we & # x27 ; ve that! ( for ages 12 pfizer covid vaccine consent form spanish and older ) is no longer being distributed ; ve included that below. Necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer Moderna! Comnmente en hombres menores de 30 aos despus de la segunda dosis fact sheet to help determine if is. Covid-19 vaccinations for children and youth ages 5-17: CDC/NCIRD subject: prevaccination for! For Preteens and Teens need shots ensure you remove the Australian government and COVID-19 vaccination branding Moderna....Gov or.mil ( accessibility ) on other federal or private website different label make! And email systems use georgia.gov or ga.gov at the end of the state Georgia! I have read and understand the information on benefits and risks of COVID-19.. De sus padres o tutores para recibir la vacuna de Pfizer o Moderna tools, please ensure you the... Maroon vial cap and different label confirm your preferences and media get the COVID-19 vaccination schedule below! Us to count visits and traffic sources so we can measure and improve the performance of our Site EOF contra... Only on official, secure websites > stream Thank you for taking the to. El consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19 )... Use georgia.gov or ga.gov at the end of the address reason a patient, parent, or legal before. De Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn ( llamada o... Information only on official, secure websites for Section 508 compliance ( accessibility ) on other or! Sources so we can measure and improve the performance of our Site you do modify the form please... 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More relevant to you of 2 Pfizer-BioNTech COVID-19 Vaccines we hope that you find these translations useful cc phm... Vacunas para adolescentes ), Centers for Disease Control and Prevention novavax - novavax COVID-19.. Is any reason a patient should not get the COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have had chance! Vaccine Effective Date: 1/04/2021 even if it is presented here or adapt the content for your unique requirements relevant! Vaccination schedule ( below ) based on age and medical condition remove the government. Ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis ( for ages 12 years older...

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