A vaccine, albeit known to be a preventive measure against viruses and diseases, may have adverse effects on the human body such as allergic reactions. Symptoms may appear in a form of itching, swelling at the part of the body where the vaccine was injected, redness, or tenderness. Other symptoms may include fever, muscle pains, or malaise. These symptoms may happen 6 to 12 hours after administration of the vaccine and may persist until a couple of days. Other hypersensitive reactions may occur as well such as hives, asthma, or systemic anaphylaxis. These reactions may result from hypersensitivity from eggs. Thus, if a person is allergic to eggs, he or she must not be given vaccines that contain eggs.
This risk of causing serious harm is small. However, in case of any severe reaction such as fever, difficulty in breathing, increased heartbeat, dizziness, please see a doctor right away.
Please answer the questions below for evaluation for your qualification to receive vaccination.
COVID-19 INFORMED CONSENT
I understand that COVID-19 is an extremely contagious disease that has been declared a global pandemic by the World Health Organization (WHO). I likewise understand that there are carriers of the disease that may not show any symptoms and may still cause to spread the virus.
I hereby declare that I have received a copy of the vaccine information material. I have been informed about the benefits and risks of receiving the vaccination. I have had the opportunity to ask questions about immunization all were answered to me to my satisfaction.
I understand that I have the option to defer my treatment to a later date or refuse the treatment. I am fully aware that it is not possible to consider every complication to care. Nonetheless, I am willfully and voluntarily assuming the risk and responsibility for my actions and consequences that may result from my receiving of immunization.