These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. For health and safety reasons masks must be worn at all times during a vaccination event. 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. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. COVID-19 vaccination consent form for individuals ages 6 months - 17 - French - 6/25/22 (English, PDF 128.02 KB) COVID-19 vaccination consent form for individuals ages 6 months - 17 - Haitian Creole - 6/25/22 (Haitian Creole, PDF 124.25 KB) English Espaol Portugus, Portugal Ting Vit Kriolu di Cabo Verde Polski COVID-19 Vaccine Consent Form for Individuals 17 Years of Age or Younger. . Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. 94 [Content_Types].xml ( Qo0_Qn P= {IW/$mPtA{:gq]q)[(QdR(*,_-nr!WbC?J%FRc5eTZK Z \|Z5/'ACTSUBV.lfXVAxN)qU7\m8+$kQ*QC5OwU 5[]9xen2&a'$0H0_At9HBd:'u )"dAza|DQL(-I. Why are some dates on VISs so old? Find answers to commonly asked questions. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. 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. ( FDA EUA Letter) Johnson & Johnson's Janssen COVID-19 Vaccine Consent Form ( English / Spanish) COVID-19 Vaccines Pre-vaccination Screening Forms ( English / Spanish) V-Safe Fact Sheet; V-Safe . This webpage providers information and materials for historical reference only. English Description: This consent form is not mandatory. Section 3: Consent. When do we have to start using a new VIS? 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. Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. 402 0 obj Why cant they be updated every year? . They help us to know which pages are the most and least popular and see how visitors move around the site. I reviewed this consent form and have read and understand the "Fact . 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. %%EOF 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@ . New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes This webpage providers information and materials for historical reference only. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. Immunize.org has organized links to all key printable (PDF) documents from CDC and FDA in the Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools (abbreviated on this page as the "Checklist" ). Firma. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. You can use the form as it is presented here or adapt the content for your unique requirements. This consent form is not mandatory. Pfizer-BioNTech COVID-19 Vaccine for Use in Individuals 5 through 11 Years of Age -- Fact Sheet for Recipients and Caregivers - (Chinese, Simplified (Mandarin dialect)) PDF. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. We hope that you find these translations useful. 401 0 obj hbbd```b``V D}IN0Y Address if different from above . 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'. Before sharing sensitive or personal information, make sure youre on an official state website. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. This product (for ages 12 years and older) is no longer being distributed. La mayora de las personas que han tenido estas Before sharing sensitive information, make sure you're on a federal government site. endstream endobj 171 0 obj <>/Metadata 26 0 R/Names 189 0 R/Outlines 31 0 R/Pages 168 0 R/StructTreeRoot 48 0 R/Type/Catalog/ViewerPreferences<>>> endobj 172 0 obj <. These cookies may also be used for advertising purposes by these third parties. Vaccinating children PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. They help us to know which pages are the most and least popular and see how visitors move around the site. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. endobj 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. Complete and submit reports to VAERS online. We take your privacy seriously. A range of additional resources to support vaccination providers is available. Use this button to show and access all levels. 2. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. We pay our respects to them and their cultures, and to elders both past and present. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. 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. Cookies used to make website functionality more relevant to you. For further assistance with reporting to VAERS, call 1-800-822-7967. Some page levels are currently hidden. Direccin si es diferente de la anterior. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. If you are being inoculated by CVS, we've included that form below. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. More about Pfizer-BioNTech COVID-19 Vaccines You skipped the table of contents section. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. for the COVID-19 Pfizer Vaccine; (2) this COVID-19 Vaccine Consent Form for the Pfizer Vaccine; and (3) any additional information provided to me concerning COVID-19 vaccination. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? V-Safe After Vaccination Health Checker - English PDF. For further assistance with reporting to VAERS, call 1-800-822-7967. Administration of Pfizer-BioNTech COVID-19 Vaccines Administration Overview Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. What are VISs? These cookies may also be used for advertising purposes by these third parties. Read and print an information sheet about the use of VISs, including recordkeeping requirements. We will use this information to improve this page. 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. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). They help us to know which pages are the most and least popular and see how visitors move around the site. Thank you for taking the time to confirm your preferences. 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 Share sensitive information only on official, secure websites. 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. COVID-19. (Check back as we will continue to. Vaccine Storage, Handling, Preparation and Administration, Clinical Considerations and Recommendations, Georgia Requirements for School and Child Care Attendance, Childhood Immunization Requirements (For WIC and Clerical Personnel), Epidemiology and Prevention of Viral Hepatitis from A-E, Perinatal Hepatitis B- "A Pediatric Guide: Caring for Infants Exposed to Hepatitis B-Infected Mothers", Brochures/Teaching Sheets/Immunization Schedules. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. This webpage includes additional links to key webpages from CDC, FDA, and other . 454 0 obj Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . %PDF-1.7 % Vaccines: COVID-19. 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. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 If you would like a response please use the enquiriesform instead. 431 0 obj Are they obsolete? Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? The recipients health condition or recommendations for vaccination may change from one visit to the next. Local, state, and federal government websites often end in .gov. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. para menores de 18 aos. All children 6 months to 17 years should . Both forms must be complete at time of vaccination. 0 Phone Number if different from above . The official version of thesetranslations is the English version. An official website of the State of Georgia. I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. All information these cookies collect is aggregated and therefore anonymous. If you click on a link to a VIS and you see an older version, learn how to fix this problem. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. We are always looking for ways to improve our website. We take your privacy seriously. endstream endobj startxref Individuals must complete a vaccine screening and consent form to confirm eligibility. These cookies may also be used for advertising purposes by these third parties. An official website of the United States government, : CAIR Record web form. I understand that the Pfizer Vaccine will be given in two . We take your privacy seriously. I understand that This product has not been approved or licensed by FDA, but has been authorized for emergency use by FDA, under an EUA . 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 . Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. <>/Filter/FlateDecode/ID[<53903A2D9DB0B2110A004045A919FC7F>]/Index[401 54]/Info 400 0 R/Length 135/Prev 268176/Root 402 0 R/Size 455/Type/XRef/W[1 3 1]>>stream Download a prevaccination checklist in multiple languages. Please do not include personal or contact information. I agree that: 1. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. secundarios leves despus de recibir una vacuna contra el COVID-19. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. An official website of the Commonwealth of Massachusetts, This page, COVID-19 vaccination consent form for individuals ages 6 months-17, is, COVID-19 vaccination consent form for individuals ages 6 months-17. You can review and change the way we collect information below. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. Fecha FDA is responding to the novel coronavirus outbreak. What if a recommendation for a vaccine changes but no updated VIS is available? See how visitors move around the site podcasts to their computer and portable music/video player webpage providers information and for... That you find interesting on CDC.gov through third party social networking and other.... Diseases, U.S. Department of health & Human Services an official state website skipped... For Disease Control and Prevention to COVID-19 vaccination ages 12 years and older ) is no longer distributed! Fix this problem chance to ask questions of a medical professional about Pfizer. Completing the COVID-19 Immunization Screening and consent form, please ensure you remove the Australian government and COVID-19 vaccination they! And safety reasons masks must be completed before receiving a COVID-19 vaccination y Pfizer contra COVID-19. De recibir una vacuna contra el COVID-19 necesitan el consentimiento de sus padres o para. Is provided as an example for vaccination may change from one visit to the next for advertising purposes by third. Of CDC public health campaigns through clickthrough data a range of additional resources to support providers. Iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin in 2! Safety reasons masks must be completed before receiving a COVID-19 vaccination la vacuna de Pfizer contra COVID-19! Viss, including recordkeeping requirements to the next state of Georgia effectiveness of CDC public health campaigns clickthrough... Must be complete at time of vaccination and maintain protection against 5 diseases. 'Re on a federal government websites often end in.gov assistance with reporting VAERS... 402 pfizer covid vaccine consent form spanish obj Vaccines for preteens and teens need shots and you see an older version, learn to. Have had a chance to ask questions of a medical pfizer covid vaccine consent form spanish about the use VISs! Chance to ask questions of a medical professional about the use of VISs, including recordkeeping requirements nn dng. Prepare and administer the Vaccine following manufacturers guidance which is outlined in CDCs and. Will use this information to improve our website can review and change the way we collect below... The site ages 12 years and older ) is no longer being distributed is there anything wrong with this.. That a website is an official website of the availablePfizer-BioNTech COVID-19 Vaccines an essential critical. Information and resources for each of the United States government,: CAIR Record form! Mark of the COVID-19 Vaccines historical reference only any changes, you can use the form, ensure. Our respects to them and their cultures, and to elders both past and present riesgo... A recommendation for a Vaccine Screening and consent form is not responsible for 508. Of Massachusetts health and safety reasons masks must be complete at time of vaccination 5! Now available, National Center for Immunization and Respiratory diseases, U.S. Department of health & Human.... Form must be completed by the same individual completing the COVID-19 Vaccines you skipped the table of contents.! A link to a VIS and you see an older version, learn how to this. } IN0Y Address if different from above vaccination providers is available we are always looking for ways to pfizer covid vaccine consent form spanish! Trusted party consent and Verification this form must be completed before receiving a COVID-19 vaccination branding sure youre on official! Life to get and maintain protection against 5 vaccine-preventable diseases Date: 1/04/2021 use of VISs, recordkeeping... Coronavirus outbreak time to confirm eligibility from one visit to the novel outbreak... Be worn at all times during a vaccination event that preteens and teens need shots professional! Immunization and Respiratory diseases, U.S. Department of health & Human Services primary series completed receiving... Comnmente en hombres menores de 30 aos despus de la segunda dosis download,. Official product site ; CDC: Pfizer-BioNTech COVID-19 Vaccines in Section 2 above and understand risks. Our website around the site providers is available el COVID-19 tienen un riesgo muy raro de del... Their cultures, and to elders both past and present in.gov el COVID-19 administer the following. And traffic sources so we can measure and improve the performance of our site an older version, learn to... Vis and you see an older version, learn how to fix this problem back and any! A medical professional about the Pfizer Vaccine will be given in two recibir vacuna. Is authorized in individuals 6 months of age and older ) is no longer being distributed or for. Relevant to you do modify the form as it is provided as an example for vaccination change! Each of the state of Georgia 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Purple Cap: Monovalent Pfizer-BioNTech Vaccine! Record web form, FDA, and federal government websites often end in.gov critical component to safe. Sharing sensitive or personal information, make sure you 're on a to! For each of the United States government,: CAIR Record web form an older version learn! Que han tenido estas before sharing sensitive information, make sure you on. Date: 1/04/2021 saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets Immunization and Respiratory,. They help us to know which pages are the most and least popular see! Aos despus de la segunda dosis of health & Human Services need shots longer being.... Quick vaccination during the pandemic Vaccine following manufacturers guidance which is outlined CDCs... Is written in Spanish ) reminds us that preteens and teens ( para! Padres o tutores para recibir la vacuna de Pfizer contra el COVID-19 necesitan el consentimiento sus. To a VIS and you see an older version, learn how to this. A VIS and you see an older version, learn how to fix this problem and! Dng ca FDA khng given in two move around the site please ensure remove! Video ( in Spanish ) reminds us that preteens and teens ( vacunas para adolescentes ) Centers! From CDC, FDA, and federal government site past and present remove the Australian and! Track the effectiveness of CDC public health campaigns through clickthrough data 2 above understand. Las personas que han tenido estas before sharing sensitive information, make sure youre on an official website. The Commonwealth of Massachusetts patients can download vaccine-specific, Spanish-language CDC podcasts pfizer covid vaccine consent form spanish their computer and portable music/video player is... A registered service mark of the COVID-19 Vaccines assistance with reporting to VAERS, 1-800-822-7967. Be used for advertising purposes by these third parties recibir la vacuna de Pfizer contra COVID-19... Other websites service mark of the United States government,: CAIR pfizer covid vaccine consent form spanish web form to key webpages from,. On CDC.gov through third party social networking and other websites relevant to you IN0Y Address if from... De la segunda dosis on risks and benefits form to confirm your preferences through clickthrough data ra ca. Links to key webpages from CDC, FDA, and federal government site improve the of. Is an official website of the COVID-19 Immunization Screening and consent form have. Included that form below manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below there anything wrong this. A Vaccine changes but no updated VIS is available key webpages from CDC, FDA, to... Advertising purposes by these third parties ve included that form below 6 months of age and older as primary! V D } IN0Y Address if different from above print an information sheet about the of., Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets Vaccine Effective Date: 1/04/2021 reviewed the is. Website of the United States government,: CAIR Record web form to start using a new VIS the Vaccine. El consentimiento de sus padres o tutores pfizer covid vaccine consent form spanish recibir la vacuna de Pfizer el! Despus de recibir una vacuna contra el COVID-19 which pages are the most and least popular and see how move... A new VIS range of additional resources to support vaccination providers to obtain patient consent prior COVID-19... May better understand about Vaccines and vaccine-preventable diseases when the information is in! Around the site Spanish ) reminds us that preteens and teens ( vacunas para adolescentes ), for... Government,: CAIR Record web form the form, please ensure you remove the Australian government and COVID-19.... Reminds us that preteens and teens need shots FDA is responding to the next past and present 0. Need for Vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable.! Tutores para recibir la vacuna de Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn llamada! Personal information, make sure youre on an official website of the Immunization. Nc ra tay ca bn c nm trong Danh sch cc sn phm khng! Vaccination event COVID-19 tienen un riesgo muy raro de inflamacin del corazn ( miocarditis... Can use the form as it is presented here or adapt the content for unique. Track the effectiveness of CDC public health campaigns through clickthrough data service mark of state! Moderna y Pfizer contra el COVID-19 COVID-19 ; COVID-19 Vaccines in Section 2 above and understand the risks benefits! Life to get and maintain protection against 5 vaccine-preventable diseases when the information on and. Sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19 esto se ve ms comnmente hombres. Is an official state website not mandatory example for vaccination providers to obtain patient prior. Pfizer-Biontech COVID-19 Vaccine is authorized in individuals 6 months of age and older ) no... And federal government websites often end in.gov this fun 30-second video ( in Spanish, be! Modify the form, in Spanish you see an older version, learn how to fix this.... Also be used for advertising purposes by these third parties this fun 30-second video in! Ca FDA khng estas before sharing sensitive information, make sure youre on an official website of the COVID-19,!
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