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Stop & Shop Pharmacy Informed Consent to Receive Vaccines Name: Date of Birth: Male/Female Street: City: Zip: Phone: Medicare B #: Email: Physician: Hepatitis A Hepatitis B Varicella MMR Meningococcal.

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What are the risks of SPIKEVAX? Trouble breathing. Swelling of your face and throat. A fast heartbeat. A rash all over your body. Dizziness and weakness.

Spikevax (previously COVID-19 Vaccine Moderna)

The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) approved the updated vaccines by Pfizer-BioNTech and Moderna for everyone 6 months and older, and authorized an updated Novavax vaccine for those 12 and older in the fall of 2023.

Indication: Active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 12 years of age and older.

Manufacturer: Moderna Tx Inc.

A mRNA vaccine is made using mRNA that gives your cells instructions for how to make the spike protein found on the surface of the COVID-19 virus. After vaccination, your immune cells begin making the spike protein and displaying them on cell surfaces.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232