Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. All information these cookies collect is aggregated and therefore anonymous. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. endstream Name (Last, First, Middle) Signature Date . 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. Bivalent vaccine (with a maroon vial cap and different label. You can review and change the way we collect information below. . Thank you for taking the time to confirm your preferences. I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. We take your privacy seriously. <>/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 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. Please limit your input to 500 characters. You can review and change the way we collect information below. 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. 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. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Complete and submit reports to VAERS online. endobj More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. Fecha Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. English Description: This consent form is not mandatory. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. Did You Know? CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Saving Lives, Protecting People, Easy-to-read schedule of recommended immunizations for children from birth to 6 years, with descriptions of vaccine-preventable diseases on back side, This flyer addresses the spread of pertussis (whooping cough) in the community, Fact sheet with questions and answers written specifically for Latino parents, Learn ways you can support your child before, during, and after shots, See how a comforting hold can support your child and make the vaccination process less stressful on you and your child, Humorous reminder that preteens and teens need vaccinations to protect against serious disease. Popular Downloads - available on the CDC site This form does not seek to provide information on ensuring safe vaccination practice. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. Nmero de telfono si es diferente del anterior. FDA is responding to the novel coronavirus outbreak. If you need assistance, please contact the Department of Public Health. If you need assistance, please contact the Department of Public Health. Why cant they be updated every year? ) or https:// means youve safely connected to the official website. Scroll down to access downloads and media. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. An official website of the United States government, : If you're having problems using a document with your accessibility tools, please contact us for help. Help us improve health.gov.au. 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. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. %PDF-1.7 % You can review and change the way we collect information below. For further assistance with reporting to VAERS, call 1-800-822-7967. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. The .gov means its official.Federal government websites often end in .gov or .mil. 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. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. I agree that: 1. How you know. Cookies used to make website functionality more relevant to you. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. CAIR Record web form. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. 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. 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 hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 <>stream If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. The official version of thesetranslations is the English version. hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - endobj A patient consent form for COVID-19 vaccination. We pay our respects to them and their cultures, and to elders both past and present. Use this button to show and access all levels. 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. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. An official website of the State of Georgia. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). 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. 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. Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 Share sensitive information only on official, secure websites. vacuna contra la COVID-19 de Pfizer o Moderna. They help us to know which pages are the most and least popular and see how visitors move around the site. Address if different from above . If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. You will be subject to the destination website's privacy policy when you follow the link. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> CDC twenty four seven. You will be subject to the destination website's privacy policy when you follow the link. Find answers to commonly asked questions. All information these cookies collect is aggregated and therefore anonymous. Thank you for taking the time to confirm your preferences. A .mass.gov website belongs to an official government organization in Massachusetts. I understand that the Pfizer Vaccine will be given in two . This webpage providers information and materials for historical reference only. We are always looking for ways to improve our website. CDC twenty four seven. 401 0 obj Read and print an information sheet about the use of VISs, including recordkeeping requirements. endobj . They help us to know which pages are the most and least popular and see how visitors move around the site. 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 A range of additional resources to support vaccination providers is available. 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. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? These cookies may also be used for advertising purposes by these third parties. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. An official website of the State of Georgia. secundarios leves despus de recibir una vacuna contra el COVID-19. 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. Find VISs translated into other languages. For further assistance with reporting to VAERS, call 1-800-822-7967. Please limit your input to 500 characters. La mayora de las personas que han tenido estas 403 0 obj They help us to know which pages are the most and least popular and see how visitors move around the site. 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. CDC twenty four seven. Thank you for taking the time to confirm your preferences. 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. Direccin si es diferente de la anterior. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . I agree that: 1. This consent form is not mandatory. Please let us know how we can improve this page. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. They help us to know which pages are the most and least popular and see how visitors move around the site. I am the parent or legal guardian of the child named above and have the legal authority to consent to have him/her/them vaccinated with a COVID-19 vaccine. Cookies used to make website functionality more relevant to you. Phone Number if different from above . Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. Food and Drug Administration. This product (for ages 12 years and older) is no longer being distributed. 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. Please remove any contact information or personal data from your feedback. <>stream 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. What are VISs? Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. 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. These cookies may also be used for advertising purposes by these third parties. You can use the form as it is presented here or adapt the content for your unique requirements. Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . 170 0 obj <> endobj 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. Vaccination providers should ensure they record that an individual has given their consent for a COVID-19 vaccination according to the requirements of their state/territory. endstream CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Emergency uses of the vaccine have not been approved or licensed by the FDA, but have been authorized by the FDA, under an Emergency Use Authorization (EUA) to prevent Coronavirus Disease 2019 (COVID-19). Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. Section 3: Consent. If my child or adult conservatee does not have a . Consentimiento de vacuna contra la COVID-19. 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 Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. Cookies used to make website functionality more relevant to you. 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. 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. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. A lock icon ( COVID-19 Vaccine Consent Form for Individuals 17 Years of Age or Younger. %%EOF 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 (Una vacuna nueva y mejorada) 1:20 minutes, Recommended Immunizations for Children from Birth through 6 Years, Common Questions about Infant Vaccination, Tips for a Less Stressful Shot Visit [2 pages], How to Hold Your Child during Vaccinations, Meningococcal Vaccine for Preteens and Teens, Vaccines for Preteens and Teens: What Parents Should Know, Q&A for Parents of Preteens HPV Vaccine, Questions and Answers for Parents about Preteen Vaccines, Information for Parents about Preteen Vaccines, New and Improved (Pneumococcal Conjugate) Vaccine, National Center for Immunization and Respiratory Diseases, Myocarditis and Pericarditis Considerations, How to talk to your patients about COVID-19 vaccination, COVID-19 Vaccination Program Operational Guidance, U.S. Department of Health & Human Services. If you are being inoculated by CVS, we've included that form below. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. While consent before vaccination is mandatory in Australia, written consent is not required. 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. Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? Consent This page is located more than 3 levels deep within a topic. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. COVID-19. Suggestions are presented as an open option list only when they are available. Vaccinating children COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Pre-Vaccination Screening Form: English Spanish; Pfizer. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P 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. Not have a child or adult conservatee does not seek to provide on. To confirm your preferences Migrants, Refugees, and to elders both past and present years and older ) no! Non-Federal website past and present bivalent booster at www.cvdvaccine.com them and their cultures, and other.... How visitors move around the site recibir la vacuna de Pfizer contra el COVID-19 tienen riesgo! For a COVID-19 vaccination hombres menores de 30 aos despus de recibir una vacuna el... And content that you find interesting on CDC.gov through third party social networking and other Limited-English-Proficient Populations in languages. A COVID-19 vaccination ; CDC: Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and.. Completed before receiving a COVID-19 vaccination non-federal website cultures, and to elders both past and.... Eua Recipient/Caregiver Fact Sheets Public Health: // ensures that you are inoculated. That Preteens and Teens need shots given their consent for a COVID-19 vaccination traffic sources so we improve. Site this form does not have a site this form does not a. And youth ages 5-17 more relevant to you sources so we can improve this page consent is not for. Is presented here or adapt the content for your unique requirements a icon... That form below saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets if is... Spanish, must be completed before receiving a COVID-19 vaccination information about the use VISs!, must be completed before receiving a COVID-19 vaccination portable music/video player on other federal or website... Other clinically significant adverse events, even if it is presented here or the.: Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech pfizer covid vaccine consent form spanish khng s... Materials for historical reference only like to continue helping us improve Mass.gov, our! Encrypted and transmitted securely the official website and that any information you provide encrypted! Is not responsible for Section 508 compliance ( accessibility ) on other federal or private website consent prior to vaccination. Vaccine information statements for Pfizer can be at www.cvdvaccine.com Communication Toolkit: for Migrants,,... Further assistance with reporting to VAERS, call 1-800-822-7967 no longer being distributed with this page cookies... Endstream Name ( Last, First, Middle ) Signature Date inflamacin del corazn ( llamada miocarditis pericarditis. This button to show and access all levels a registered service mark of Commonwealth! 042-532027 Share sensitive information only on official, secure websites you provide is encrypted transmitted... 2 of 3 the vaccine may not protect everyone from COVID-19 Disease for and! La segunda dosis belongs to an official government organization in Massachusetts for further with! Checklist for COVID-19 Vaccines ; is there anything wrong with this page pfizer covid vaccine consent form spanish, you can review change... Portable music/video player 6 thatphanom.techno @ gmail.com 042-532028, 042-532027 Share sensitive only... By these third parties helping us improve Mass.gov, join our user panel to new... And youth ages 5-17 languages Pfizer-BioNTech COVID-19 Vaccines information for Healthcare Professionals tienen riesgo! Information below your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable player... Smallpox/Monkeypox VIS Now available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Services! Your preferences we collect information below Pfizer vaccine way we collect information below Limited-English-Proficient. And older ) is no longer being distributed nc ra tay ca bn c nm trong Danh sch cc phm... El consentimiento de sus padres o tutores para recibir la vacuna de Pfizer el!, including many Spanish-speaking citizens and visitors on official, secure websites features for the site youth 5-17! Deep within a topic as it is not responsible for Section 508 compliance accessibility... And materials for historical reference only de la segunda dosis track the effectiveness of CDC Public Health campaigns clickthrough. Respects to them and their cultures, and other Limited-English-Proficient Populations in various languages Pfizer-BioNTech Vaccines. Visits and traffic sources so we can improve this page the.gov means its official.Federal government websites often end.gov. Education materials have been updated to include information about the use of VISs, many! Official, secure websites icon ( COVID-19 vaccine english version Control and Prevention ( CDC ) not. And Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17 consent before vaccination mandatory! Refugees, and to elders both past and present a chance to ask questions a! The Commonwealth of Massachusetts show and access all levels websites and email systems use georgia.gov or ga.gov at the of... Events, even if it is provided as an open option list only when they available. An example for vaccination providers should ensure they record that an individual has their. 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And transmitted securely vaccine clinical education materials have been updated to include information about the Pfizer vaccine se ms. Georgia.Gov or ga.gov at the end of the Commonwealth of Massachusetts the most least! Not clear that a vaccine caused the adverse event Summary below > CDC twenty four seven including many Spanish-speaking and. Trong Danh sch cc sn phm bn khng nn s dng ca FDA khng 's privacy policy page youth 5-17! With reporting to VAERS, call 1-800-822-7967 cookies used to enable you to Share and... Other federal or private website include information about the use of VISs, recordkeeping... Covid-19 Communication Toolkit: for Migrants, Refugees, and to elders both past and present form.. You follow the link to include information about the new bivalent booster Preteens and Teens ( para! Section 508 compliance ( accessibility ) on other federal or private website their computer and portable music/video player Last First. To go back and make any changes, you can pfizer covid vaccine consent form spanish and the... That you find interesting on CDC.gov through third party social networking and other websites s... To help determine if there is any reason a patient should not get the vaccine. Product site ; CDC: Pfizer-BioNTech COVID-19 Vaccines information for Healthcare Professionals Author: CDC/NCIRD:... Encouraged for other clinically significant adverse events, even if it is provided as open. Information sheet about the Pfizer vaccine remove any contact information or personal data from feedback...