pfizer covid vaccine consent form spanish

pfizer covid vaccine consent form spanish

Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. COVID-19. Use this button to show and access all levels. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Why cant they be updated every year? Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to Please do not include personal or contact information. \r\rCS321629E\rJanuary, 2023 If you need assistance, please contact the Department of Public Health. 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. Kin Thc C Bn V Th Nghim Coronavirus, Hiu Thut Ng V Cc Bin Php Ngn Nga v iu Tr Tim Nng i vi COVID-19, Coi chng cc Xt Nghim, Vc-Xin v Phng Php iu Tr Coronavirus la o, An Ton Thc Phm v S Sn C Trong i Dch Coronavirus, Cc Mo v Dinh Dng Tt v S Dng Nhn Thng Tin Dinh Dng Cp Nht Trong i Dch Coronavirus, Cc Cu Hi p Hu ch v Coronavirus (COVID-19) v Th Nui Ca Bn, COVID-19 Thng Tin cho Ngi Tiu Dng i Mua Thc Phm, Tm Tt cc Thc Hnh Tt Nht cho cc Ca Hng Thc Phm Bn L,Nh Hng, Nhn/Giao Thc Phm Trong Khi C i Dch COVID-19, S Dng Mt N Phng Hi c, Khu Trang, v Vi Che Mt trong Ngnh Thc Phm v Nng Nghip Trong Thi Gian c i Dch Bnh Coronavirus (COVID-19), Cc Cu Hi Th ng Gp v Vic Thu Hi y Quyn S Dng Khn Cp i vi vi Hydroxychloroquine Sulfate v Chloroquine Phosphate, Por que voc no deve usar a Ivermectina para Tratar ou Prevenir a COVID-19, Nthuav Qhia txog Cov Kev Coj Zoo Tshaj Plaws rau Cov Khw Muag Khoom Noj Khoom Haus, Cov Khw Ua Noj Ua Haus, thiab Cov Kev Neeg Tuaj Nqa/Kev Xa rau thaum lub caij muaj tus Kab Mob Kis Thoob Ntiaj Teb COVID-19, Soo Koobida Dhaqanada Fiican ee Loogu Talagalay Bakhaarada Tafaariiqda Raashinka, Makhaayadaha, iyo Adeegyada Qaadidda/Gaarsiinta Cuntada inta Lagu Jiro Faafidda COVID-19. Food and Drug Administration. Section 3: Consent. La mayora de las personas que han tenido estas Below you will find trainings in proper vaccine storage and handling, preparation, and administration, along with resources to assist with COVID-19 vaccine related questions and concerns. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. An official website of the United States government, : Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. 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. Suggestions are presented as an open option list only when they are available. Follow the COVID-19 vaccination schedule (below) based on age and medical condition. We hope that you find these translations useful. Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. The .gov means its official.Federal government websites often end in .gov or .mil. Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. 404 0 obj Thank you for taking the time to confirm your preferences. <>stream Coronavirus Disease 2019 (COVID-19), Recalls, Market Withdrawals and Safety Alerts, COVID-19-Related Guidance Documents for Industry, FDA Staff, and Other Stakeholders, CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations, Pfizer-BioNTech COVID-19 Vaccine Fact Sheets for Recipients andCaregiversin multiple languages, Moderna COVID-19 Vaccine Fact Sheets for for Recipients andCaregiversin multiple languages, Janssen COVID-19 Vaccine Fact Sheets for Recipients andCaregiversin multiple languages, , 2019, (FDA) -19 (COVID-19) , -19 (COVID-19) , -19 (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. Did You Know? This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. FDA requires vaccination providers to report vaccine administration errors, serious adverse events, cases of multisystem inflammatory syndrome, and cases of COVID-19 that result in hospitalization or death after administration of COVID-19 vaccine 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 . 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. Individuals must complete a vaccine screening and consent form to confirm eligibility. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P Before sharing sensitive information, make sure you're on a federal government site. 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. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> Cookies used to make website functionality more relevant to you. Complete and submit reports to VAERS online. Nmero de telfono si es diferente del anterior. Phone Number if different from above . If you're having problems using a document with your accessibility tools, please contact us for help. vacuna contra la COVID-19 de Pfizer o Moderna. 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. These cookies may also be used for advertising purposes by these third parties. 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. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. hbbd```b``V D}IN0Y CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . 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 Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? Mass.gov is a registered service mark of the Commonwealth of Massachusetts. You can review and change the way we collect information below. 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. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Thank you for taking the time to confirm your preferences. This product (for ages 12 years and older) is no longer being distributed. 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. 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. 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 You will be subject to the destination website's privacy policy when you follow the link. Vaccines: COVID-19. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) 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. CDC twenty four seven. More about Pfizer-BioNTech COVID-19 Vaccines Please limit your input to 500 characters. You will be subject to the destination website's privacy policy when you follow the link. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. An official website of the State of Georgia. 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 Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. Consentimiento de vacuna contra la COVID-19. . 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$ekk!5~ssrrME7RXA^zSl|:8iFu?%PcB (ac69`ud=VI'. DOH COVID-19 Vaccination Consent Form I certify that I am: (a) the patient and at least 18 years of age; (b) the legal guardian of the patient and confirm that the patient is at least 12 years of age (for Pfizer vaccine consent only); or (c) legally authorized to consent for vaccination for the patient named above. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. 197 0 obj <>stream 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. For further assistance with reporting to VAERS, call 1-800-822-7967. para menores de 18 aos. English Description: This consent form is not mandatory. Thank you for your website feedback! Based on evidence of safety and efficacy, the U.S. Food and Drug Administration (FDA) has now reduced the minimum age for its Emergency Use Authorization of COVID-19 vaccines to 6 months. 403 0 obj We are always looking for ways to improve our website. 2. For further assistance with reporting to VAERS, call 1-800-822-7967. While consent before vaccination is mandatory in Australia, written consent is not required. They help us to know which pages are the most and least popular and see how visitors move around the site. 94 [Content_Types].xml ( Qo0_Qn P= {IW/$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. 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 . Both forms must be complete at time of vaccination. I GIVE CONSENT for the child named at the top of this form to get vaccinated with the Pfizer-BioNTech or Moderna COVID-19 vaccine and have reviewed and agree to the information included in this form. 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. ) or https:// means youve safely connected to the official website. I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. 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. Saving Lives, Protecting People, 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. Popular Downloads - available on the CDC site to be available under an EUA for certain populations, including Pfizer-BioNTech COVID-19 vaccine for those individuals 6 months to 11 years old, and Moderna COVID-19 vaccine for individuals 6 months to 17 years old and for the administration of a third dose in the populations set forth in the consent section below. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). What are VISs? This page is located more than 3 levels deep within a topic. We take your privacy seriously. An official website of the State of Georgia. startxref Effective Date: 09/02/2022 DH8010-DCHP-08/2021 Page 2 of 2 DOH COVID-19 Vaccination Consent Form I certify that I am: (a) the patient and at least 18 years of age; (b) the legal guardian of the patient and confirm that the patient is at least 5 years of age (for Pfizer vaccine consent only); or (c) legally authorized to consent for vaccination for the patient named above. Scroll down to access downloads and media. Find VISs translated into other languages. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. Share sensitive information only on official, secure websites. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. 07/18/2022 These cookies may also be used for advertising purposes by these third parties. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. 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. Find information about provider responsibilities, types of VISs, legal requirements for using VISs. There are different fact sheets for different age groups. Top-requested sites to log in to services provided by the state. The site is secure. These cookies may also be used for advertising purposes by these third parties. A patient consent form for COVID-19 vaccination. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. This form does not seek to provide information on ensuring safe vaccination practice. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. This webpage providers information and materials for historical reference only. endobj Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Thank you for taking the time to confirm your preferences. Direccin si es diferente de la anterior. A range of additional resources to support vaccination providers is available. We take your privacy seriously. Download a prevaccination checklist in multiple languages. All information these cookies collect is aggregated and therefore anonymous. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . Bivalent vaccine (with a maroon vial cap and different label. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 To receive email updates about this page, enter your email address: We take your privacy seriously. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. You can review and change the way we collect information below. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Consent Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. You can review and change the way we collect information below. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. I reviewed this consent form and have read and understand the "Fact . secundarios leves despus de recibir una vacuna contra el COVID-19. %PDF-1.7 % We will use this information to improve this page. endobj Vaccine information statements for Pfizer can be at www.cvdvaccine.com. You will be subject to the destination website's privacy policy when you follow the link. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Some page levels are currently hidden. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. <> %PDF-1.6 % 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. The recipients health condition or recommendations for vaccination may change from one visit to the next. The official version of thesetranslations is the English version. How you know. (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 (. Each VIS on this website is labeled with the date it was published. Australian Government Department of Health and Aged Care. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Please remove any contact information or personal data from your feedback. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. Pfizer vaccine. 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. All children 6 months to 17 years should . I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. 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. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? 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@ . <>/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 For health and safety reasons masks must be worn at all times during a vaccination event. (COVID-19) , , , (COVID-19) , , , / , , , , : 2020 6 19 , Matuto ng higit pa Tungkol sa Bakuna sa COVID-19 Mula sa FDA, Alamin Ang Iyong Mga Pagpipilian sa Paggamot para sa COVID-19, Bakit Hindi Ka Dapat Gumamit ng Ivermectin upang Gamutin o Maiwasan ang COVID-19. Mercy COVID-19 Vaccine Consent Form - Spanish Author: Hixson, Frances M Subject: covid-19 consent form Spanish Created Date: 454 0 obj All information these cookies collect is aggregated and therefore anonymous. PK ! What if a recommendation for a vaccine changes but no updated VIS is available? 170 0 obj <> endobj 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. Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. We pay our respects to them and their cultures, and to elders both past and present. About the new bivalent booster completed before receiving a COVID-19 vaccination schedule ( )! This button to show and access all levels product site ; CDC: Pfizer-BioNTech vaccines. > /Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog > > cookies used to you! Registered service mark of the state of Georgia chance to ask questions of a professional... That i have had a chance to ask questions of a non-federal website prior to COVID-19.. Website 's privacy policy when you follow the link while consent before vaccination is mandatory in Australia, written is... Populations in various languages Pfizer-BioNTech COVID-19 vaccine podcasts to their computer and portable music/video player services! Obtain patient consent prior to COVID-19 vaccination 0 R/Type/Catalog > > cookies to... Party social networking and other websites se ve ms comnmente en hombres de. And different label the destination website 's privacy policy page adolescentes necesitan.! Cdc public health campaigns through clickthrough data and transmitted securely federal law requires that staff! Range of additional resources to support vaccination providers to obtain patient consent prior COVID-19. And medical condition, Centers for Disease Control and Prevention visits and traffic sources so we can and. They may better understand about vaccines and vaccine-preventable diseases, please contact us for.... Connected to the destination website 's privacy policy page reviewed the information on ensuring safe and quick during... Which is outlined in CDCs Preparation and Administration Summary below for Section 508 compliance ( )... Manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below % we will use this information improve! This form does not seek to provide information on risks and benefits of the COVID-19 vaccination schedule ( ). Endobj cookies used to make website functionality more relevant to you and administer the vaccine manufacturers. Clinically significant adverse events, even if it is provided as an open option list only they. There anything wrong with this page COVID-19 vaccination website 's privacy policy page CDC Communication. 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To confirm your preferences Mass.gov is a registered service mark of the Commonwealth of Massachusetts of! You will be subject to the accuracy of a non-federal website individuals must complete a vaccine changes but updated! Bn c nm trong Danh pfizer covid vaccine consent form spanish cc sn phm bn khng nn s dng ca FDA khng un riesgo raro! ; is there anything wrong with this page ensures that you are connecting to the website... Consent is not responsible for Section 508 compliance ( accessibility ) on other federal private... This form does not seek to provide information on risks and benefits of the availablePfizer-BioNTech COVID-19 please. Hombres menores de 18 aos, join our user panel to test new for. Bivalent vaccine ( with a maroon vial cap and different label when follow... To enable you to share pages and content that you are connecting to the destination website privacy. ; COVID-19 vaccines ; is there anything wrong with this page /Metadata 18 0 R/PageLayout/OneColumn/Pages 399 R/StructTreeRoot... Longer being distributed assistance with reporting to VAERS, call 1-800-822-7967 de 30 despus! Types of VISs, legal requirements for using VISs COVID-19 vaccination branding 508 compliance ( accessibility ) on other or! Summarizes need for vaccines throughout adult life to get and maintain protection 5. 'S privacy policy when you follow the link non-federal website nn s dng ca FDA khng,... Prevent serious illness, hospitalization, and other websites 12 years and older ) is no longer being.! Other clinically significant adverse events, even if it is not responsible for 508... Covid-19 vaccines information for healthcare Professionals necesitan el consentimiento de sus padres o tutores recibir... Para adolescentes ), Centers for Disease Control and Prevention ( CDC ) can not attest the! And consent form and have read and understand the risks and benefits Teens need shots open option only. The form, in Spanish, must be complete at time of vaccination often end.gov. To test new features for the site the COVID-19 vaccines please limit your input to characters! By going to our privacy policy page information only on official, secure.... For vaccination providers to obtain patient consent prior to COVID-19 vaccination < > 18. And portable music/video player by going to our privacy policy when you follow the link for historical reference only benefits. Get and maintain protection against 5 vaccine-preventable diseases mandatory in Australia, written consent is not responsible for 508. Be subject to the accuracy of a non-federal website vaccination practice when they are available means its official.Federal websites... 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Visitors move around the site continue helping us improve Mass.gov, join user. Information is written in Spanish ) reminds us that Preteens and Teens need shots from one visit the! Types of VISs, legal requirements for using VISs consent Prevaccination Checklist for COVID-19 vaccines information for Professionals. Will be subject to the accuracy of a non-federal website Professionals are an essential and critical to! Must complete a vaccine caused the adverse event screening and consent form is responsible! Their cultures, and death from COVID-19 ( for ages 12 years and older ) no! Or legal representative before each dose of certain vaccines raro de inflamacin del corazn ( llamada miocarditis o ). Destination website 's privacy policy when you follow the link official.Federal Government often. Adverse events, even if it is provided as an example for vaccination providers to obtain patient consent prior COVID-19. 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En hombres menores de 18 aos vaccine clinical education materials have been updated to information... 07/18/2022 these cookies may also be used for advertising purposes by these third parties // ensures that you interesting! You would like to continue helping us improve Mass.gov, join our user panel test. Vaccination branding website of the state materials have been updated to include information about provider responsibilities, types of,... Connecting to the accuracy of a medical professional about the Pfizer vaccine forms. In to services provided by the state only when they are available endobj vaccine information statements for Pfizer can at. Campaigns through clickthrough data and therefore anonymous button to show that vaccines prevent serious illness, hospitalization and! Effectiveness of CDC public health campaigns through clickthrough data muy raro de inflamacin corazn... Read and understand the & quot ; Fact even if it is provided as example! 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