Moderna Vaccine Specific Information

Consent Form

• Priority Screening & Consent Form under EUA (pdf)
• Priority Screening & Consent Form under EUA (Word Document)
• COVID-19 Vaccination Consent under Emergency Use Authorization
• COVID-19 Vaccination Consent under Emergency Use Authorization (Spanish)

Patient Vaccination Card

• Patient Vaccination Card
  _{(Should be printed on 120-lb card stock, size of card should be 4.25" x 3.5")}

Fact Sheets

Please select the language you would like to view the EUA Fact Sheet (Recipients) below:

• Moderna EUA Fact Sheet (Vaccinators)
• Moderna EUA Fact Sheet (Recipients)
• Moderna ACIP Interim Use Recommendations
• Missouri Standing Order – Moderna

V-Safe Patient health Check-in App

• Information Sheet
• Poster

Storage

• Storage Summary
• Freezer Vaccine Storage Logger (Celsius)
• Freezer Vaccine Storage Log (Fahrenheit)

Labels

• Storage Label
• Beyond Use Date (BUD) Tracking Labels

Tools

• Vaccine Expiration Date Tracker