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COVID-19 Vaccination Comirnaty (Pfizer)

Before completing this form, make sure you have read the information sheet on the vaccine you will be receiving, COVID-19 Vaccine Comirnaty (Pfizer).  https://www.tga.gov.au/sites/default/files/cmi-comirnaty-bnt162b2-mrna.pdf

Important information:

You are only eligible for a booster dose of COVID-19 vaccine if you meet the following requirements:

  • You are over 18 years of age, and
  • Had a previous dose of COVID-19 vaccination at least 3 months ago. If you schedule your appointment earlier, you will be turned away until you are eligible.
    • For example second COVID-19 vaccine completed on the 15th of November 2021, eligible to receive your booster from (and not before) the 15th of February 2022.

For more information on eligibility, please refer to the Department of Health website

Tell your healthcare provider if you have any side effects after vaccination that you are worried about.  You may be contacted by SMS within the week after receiving the vaccine to see how you are feeling after vaccination. Some people may still get COVID-19 after vaccination.  

You must still follow public health precautions as required in your state or territory to stop the spread of COVID-19 including:
  • keep your distance – stay at least 1.5 metres away from other people
  • washing your hands often with soap and water, or use hand sanitiser
  • wear a mask
  • stay home if you are unwell with cold or flu-like symptoms, and arrange to get a COVID-19 test.

Vaccination providers record all vaccinations on the Australian Immunisation Register, as required by Australian law.  You can view your vaccination record online through your:
  • Medicare account
  • MyGov account
  • MyHealthRecord account

How the information you provide is used

For information on how your personal details are collected, stored and used visit https://www.health.gov.au/using-our-websites/privacy/privacy-notice-for-covid-19-vaccinations

On the day you receive your vaccine

Before you get vaccinated, tell the person giving you the vaccination if you:

  • Have had an allergic reaction, particularly anaphylaxis (a severe allergic reaction) to a previous dose of a COVID-19 vaccine, to an ingredient of a COVID-19 vaccine, or to other vaccines or medications.
  • Are immunocompromised.  This means that you have a weakened immune system that may make it harder for you to fight infections and other diseases.  You can still have a COVID-19 vaccine, but may wish to consider the best timing of vaccination depending on your underlying condition and/or treatment.

Find out more about the Pfizer COVID-19 vaccine:

Department of Health - Comirnaty (Pfizer)

 

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Personal Details

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AIR Information

The Australian Government has recently introduced new legislation that makes it mandatory for vaccination providers to report vaccinations to the Australian Immunisation Register (AIR). Strengthening reporting to the AIR and ensuring that all vaccinations are included will mean that health authorities can avoid unnecessary re-vaccination and rely on a complete and reliable dataset of all vaccines administered in Australia. The Department of Health notes that there are existing and strong provisions under the AIR Act that provide individuals with control over their personal information. If you choose to receive a vaccination at VaxiCare1 Pty Ltd, a record of this treatment will be securely sent to the AIR.
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Terms and Conditions

Your booking is not yet confirmed. Please answer the following consent checklist questions to complete your booking:

If you require assistance completing this form, the Easy Read Consent Form may be helpful: https://www.health.gov.au/sites/default/files/documents/2021/12/covid-19-vaccination-consent-form-easy-read_0.pdf

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Terms & Conditions

In addition to the Terms & Conditions on the previous screen when confirming your booking you agree the following:

  1. I am at least 18 years of age.
  2. I have read and understand information on precautions, contraindications and side effects am aware of and accept any risks associated with the Vaccination and to my knowledge I do not suffer from any condition or circumstance that prevents me from having the Vaccination or makes it unsafe for me.
  3. I will answer truthfully if the nurse asks for specific information about my health, past vaccinations or other conditions that may affect my participation.
  4. I will immediately inform the nurse of any adverse changes I experience in the course of participating in the Vaccination or afterwards, including (but not limited to): discomfort, pain, dizziness, shortness of breath, wheezing, difficulty breathing, swelling of the face, lips, tongue or other parts of the body.
  5. I understand that as part of receiving the Vaccination, BizHealth Consultants must securely submit a record of my Vaccination to the Australian Immunisation Register (AIR).
 
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