Ministry of Health and Wellness

Belize

Pfizer- BioNTech BNT162b2 Tozinameran (COMINARTY™) vaccination consent form

The Pfizer COVID-19 Vaccine was listed by WHO for emergency use on December 31st, 2020 to prevent
COVID-19 in individuals 12 years of age and older, under an Emergency Use Authorization (EUA).

The Pfizer Vaccine is being offered to your child. Two doses are required, 21 days apart. The vaccine
significantly reduces the chances of infection and symptomatic disease for your child and it helps to prevent
severe illness if infected.

Please answer and sign below:

I have received a leaflet, accompanying this consent form, with further information on the Pfizer vaccine.
YES  NO .

I have read the information contained within this leaflet. YES  NO 

I hereby confirm that I was given information on the Pfizer vaccine, including the most common side effects;
which I shall report to the nearest health care provider or health facility.

Please fill the data requested below:

Child’s name

School’s name

Consent for full course Pfizer vaccine

I WANT my child to receive the full course of two doses of Pfizer vaccine

Name of parent or caregiver, relationship and phone number

Signature and date

 Ministry of Health and Wellness
Belize

Fact Sheet on Pfizer- BioNTech BNT162b2 Tozinameran (Comirnaty) Vaccine

(Pfizer vaccine)

WHAT IS COVID-19?

COVID-19 disease is caused by a coronavirus called SARS-CoV-2. It is predominantly a

respiratory illness that can affect other organs. This type of coronavirus has not been seen before.
It can be transmitted through contact with another person who has the virus and by touching
contaminated surfaces after an infected person touches their eyes, nose or mouth without
cleaning their hands.

People with COVID-19 have had mild to severe forms of the illness. Symptoms may appear 2 to
14 days after exposure to the virus and may include: fever or chills; cough; shortness of breath;
fatigue; muscle or body aches; headache; loss of taste or smell; sore throat; congestion or runny
nose; nausea or vomiting; and diarrhea.

The COVID -19 pandemic has caused significant number of illness and death throughout the
world, as well as major social, educational and economic disruptions. The Pfizer Vaccine, was
listed by the World Health Organization (WHO) for emergency use on December 31st, 2020.
The United States (US) Food and Drug Administration (FDA) granted Emergency Use
Authorization (EUA) for emergency use of the Pfizer vaccine for the prevention of COVID 19
on December 11, 2020.

WHO SHOULD GET THE PFIZER VACCINE?

The Pfizer vaccine is authorized for individuals 12 years of age and older.

WHO SHOULD NOT GET THE PFIZER VACCINE?

− Anyone who has had a severe allergic reaction after a previous dose of this vaccine
− Anyone who has had a severe allergic reaction to any ingredient of this vaccine

Anyone with an acute febrile illness (body temperature over 37.5 C) should postpone vaccination
until they are afebrile.

Persons with acute COVID 19 should defer vaccination until three months after.
HOW IS THE PFIZER VACCINE GIVEN?

The Pfizer vaccine is an intramuscular injection into the deltoid muscle on the arm. Two doses
will be given 21 days apart. Persons receiving one dose of the Pfizer Vaccine, should receive a
second dose of this same vaccine to complete the vaccination series.

WHAT ARE THE BENEFITS OF THE PFIZER VACCINE?

The Pfizer Vaccine reduces hospitalization, severity of the disease and death.

SIDE EFFECTS OF THE PFIZER VACCINE

The minor side effects are:

− Pain, swelling and redness at the injection site

− Tiredness, headache, muscle pain, fever, chills, joint pain, and swollen lymph nodes
− Feeling unwell, nausea, diarrhea and vomiting
 A small number of severe allergic reactions have been reported within a few minutes
after vaccination. Hence, the recommendation to monitor the persons receiving the
vaccine for at least 15 minutes.
 If you experience difficulty breathing, swelling of face and throat, a fast heartbeat or a
rash or hives over the body, seek medical care immediately.

How to report SIDE EFFECTS?

Report all side effects to the phone number shared on the information sheet given when the
vaccine was administered.

WHERE IS THE VACCINE AVAILABLE?

Contact your local health team for updates of the scheduled vaccination sites.

REMINDER

Continue the proper use of face masks covering nose and chin, keep physical distance, wash
hands often, keep surfaces clean, avoid crowds.

Additional information, about the Pfizer vaccine can be obtained from any health care provider
(doctor or nurse) at any of the health facilities near you.