This is an HTML version of an attachment to the Official Information request 'Protocol to fully inform covid vaccine recipients'.
Appendix One
Getting your COVID-19 
vaccine: 
Released 
what to expect 
Vaccines are one of the ways we can fight the 
COVID-19 pandemic and protect the welfare 
and wellbeing of our communities.
under 
Protection 
Safety
COVID-19 vaccines are free and available to 
Medsafe  only grants consent for a vaccine to be 
everyone in New Zealand.
used in New Zealand once they are satisfied it’s 
the 
safe and effective enough to use. All COVID-19 
Vaccines protect your health and prevent disease 
vaccines will go through the same safety test and 
by working with your body’s natural defences so 
must meet the same robust standards.  
you are ready to fight the virus, if you are exposed. 
Official 
The COVID-19 vaccine works by triggering your 
Pfizer vaccine
immune system to produce antibodies and blood 
This vaccine will not give you COVID-19. You’ll 
cells that work against the COVID-19 virus.
need two doses, three weeks apart. To ensure 
Getting a COVID-19 vaccine is an important step 
you have the best protection, make sure you get 
you can take to protect yourself from the effects 
both doses of the vaccine. If you can’t make your 
Information 
of the virus. However, we don’t yet know if it will 
appointment, reschedule as soon as possible.
stop you from catching and passing on the virus. 
Things to consider before getting 
Once you’ve been vaccinated, continue to take 
precautions to prevent the spread of COVID-19. 
your vaccine
Thoroughly wash and dry your hands. Cough or 
If you have had a severe or immediate allergic 
sneeze into your elbow and stay home if you feel 
reaction to any vaccine or injection in the past, 
unwell. This will help you protect yourself, your 
please discuss this with your vaccinator.
whānau and others.
If you are on blood-thinning medications or have 
Continue using the COVID tracer app, turn on 
a bleeding disorder, please let your vaccinator 
Act 
your phone’s Bluetooth function, and you may 
know.
wish to wear a face covering or mask.
If you are pregnant or breastfeeding, please talk 
to your vaccinator, GP or midwife.  
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HP7557 | 15 February 2021

Appendix One
If you are receiving the cancer drugs Keytruda, 
Opdivo, Yervoy, or Tecentriq, talk with your 
Further support and information
specialist about whether you should receive the 
vaccine. 
If you experience symptoms that could be 
COVID-19 related, such as a new continuous 
We are not currently offering the Pfizer vaccine 
cough, a high temperature/fever or a loss or 
Released 
to those under 16 years of age until further data is 
change in your normal sense of taste or smell, 
available.
stay home and get a COVID-19 test.  
If you have symptoms of COVID-19, get a test and 
If you are unsure about your symptoms or if they 
stay at home until you get your results. You can be 
get worse, call Healthline on 0800 358 5453.
vaccinated once you have a negative test.
If you have an immediate concern about your 
What happens after my  
safety, call 111, and make sure you tell them 
you’ve had a  COVID-19 vaccination so that they 
vaccine?
can assess you properly.
under 
You’ll need to wait 30 minutes after your 
vaccination so medical staff can check you do 
www.health.govt.nz/covid-vaccine
not have a serious allergic reaction.
Potential side effects the 
The most common reported reactions are pain at 
the injection site, a headache and feeling tired or 
fatigued.
Official 
Muscle aches, feeling generally unwell, chills, 
fever, joint pain and nausea may also occur. This 
shows that the vaccine is working.
Like all medicines, the vaccine may cause side 
effects in some people. These are common, are 
Information 
usually mild and don’t last long and won’t stop 
you from having the second dose or going about 
your daily life.
Some side effects may temporarily affect your 
ability to drive or use machinery.
Serious allergic reactions do occur but are 
extremely rare. Our vaccinators are trained to 
manage these. 
Act 1982

Appendix One
After your immunisation
Like all medicines, the vaccine may cause side effects in some people. This is 
Released 
the body’s normal response and shows the vaccine is working. Side effects are 
usually mild, don’t last long and won’t stop you from having the second dose or 
going about your daily life.
 What you may feel
 What can help
 When this could start
under 
Pain at the injection site, a 
Place a cold, wet cloth, or ice 
Within 6 to 24 hours 
headache and feeling tired 
pack on the injection site for a 
and fatigued. These are the 
short time. 
most commonly reported side 
effects. 
Do not rub or massage the 
injection site.
the 
Muscle aches, feeling generally 
Rest and drink plenty of fluids
Within 6 to 48 hours 
unwell, chills, fever, joint pain 
Official 
and nausea may also occur.  
Paracetamol or ibuprofen 
can be taken, follow the 
manufacturer’s instructions. 
Seek advice from your health 
professional if your symptoms 
worsen.
Information 
Serious allergic reactions can occur but are 
You can also report any unexpected reactions 
extremely rare. New Zealand vaccinators are 
direct by emailing CARM or using their online 
trained to manage these. Some side effects 
reporting form on the CARM website  
may temporarily affect the ability to drive or use 
otago.ac.nz/carm.
machinery. In the unlikely event this happens, 
please discuss it with your employer.
If you are unsure about your symptoms or they 
get worse, talk to your GP or call Healthline on 
If you experience symptoms that could be 
0800 358 5453.
Act 
COVID-19 related, such as new continuous cough, 
a high temperature/fever, or a loss of or change 
If you have an immediate concern about your 
in your normal sense of taste or smell, stay home 
safety, call 111 and make sure you tell them you’ve 
and get a COVID-19 test.  
had a COVID-19 vaccination so that they can 
1982
assess you properly.
If you have an unexpected reaction to your 
COVID-19 vaccination, your vaccinator or health 
professional should report it to the Centre for 
Adverse Reactions Monitoring (CARM). 
HP7558 | 16 February 2021

Appendix One
COVID-19 vaccination 
consent form - border/MIQ worker
This form is to be used for Tier 1a only 
Released 
Patient 
Surname    ……………………………………………….................         First name    ……………………………………………...................
Phone   ……………………………………………… 
Date of birth   ………  / ………  / ………          NHI   ……………………………..
Address   ………………………………………………………………………………………………………………………………………………................
Medical Centre/GP   .............................................................................................
under 
Guardian 
Name of guardian (if applicable)    ………………………………………………………………………………
Guardian’s relationship to patient    ………………………………………………
the 
Please let the vaccinator know:    
•  If you are unwell  
Official 
•  If you’ve had a previous severe allergic reaction to any vaccine or injection in the past 
•  If you’re on blood-thinning medications or have a bleeding disorder
•  If you’ve had any vaccines in the past four weeks
•  If you are pregnant or breastfeeding  
•  If you are currently receiving the cancer drugs Keytruda, Opdivo, Yervoy, or Tecentriq or have done 
Information 
so in the past six months
 
 
I have read the COVID-19 information pamphlet on “What to Expect”,  and/or have had explained to me 
information about the COVID-19 vaccine.
I have had a chance to ask questions and they were answered to my satisfaction. 
I believe I understand the benefits and risks of COVID-19 vaccination. 
I understand it is my choice to get the COVID-19 vaccination. 
Act 
Signature     ……………………………………………………………….            Date     ………  / ………  / ………
1982
 
I also consent to share with my employer, that I have been given the COVID-19 vaccine.
Signature     ……………………………………………………………….            Date     ………  / ………  / ………
HP7565    |   19 February 2021

Appendix One
Information for Vaccinator
 
Details confirmed
Released 
Positive answer to any screening questions?   Yes              No 
  
Record information and advice given:  
 
Informed consent obtained?   Yes              No 
  
Date     ………  / ………  / …….            Time     ………...............                 
 
under 
If deferred, declined or not medical fit for vaccine record detail    .............................................
................................................................................................................................................................................
the 
Vaccine
Diluent
Name of vaccine
Date
Time
Dose
Site
Batch
Expiry
Batch
Expiry
Time of 
reconstitution
Official 
Pfizer/BioNTech 
0.3ml
COVID-19 
Vaccine
    Dose 1
Dose 2
Information 
Post vaccination information given
Signature of vaccinator   ……………………………….......
Name of vaccinator    …………………………………………..
Observation area information
Act 
Signature    ………………………………………………………………
Details of any AEFI or observations recorded
Departure time    ………............... 
CARM Report completed
1982

Appendix One
Released 
Privacy
 
All the information you provide today will be 
under 
used to help run the COVID-19 vaccination 
programme. Information from the consent form 
and details of each immunisation given or turned 
down will be recorded by the Ministry of Health in 
the COVID-19 Immunisation Register. 
the 
This information will be treated with care 
to ensure the Ministry of Health meets its 
obligations under the Privacy Act 2020 and the 
Official 
Health Information Privacy Code 2020.  
The information collected as part of the 
Sharing information with employers
vaccination process may be used for:
Your employer may request confirmation of you 
•  managing your health
receiving a vaccine. They should email COVID-19.
Information 
•  keeping you and others safe
[email address] to request access.  
•  planning and funding health services
Further information
•  carrying out authorised research
•  training health care professionals
For more information about how the Ministry 
of Health protects your information, visit the 
•  preparing and publishing statistics
Ministry website at health.govt.nz/covid-
•  improving government services. 
vaccine-privacy or email COVID-19.privacy@
health.govt.nz
 
Act 
Some information, such as information about 
reactions to the vaccine, will be shared with other 
organisations who provide health services such 
1982
as the Centre for Adverse Reactions Monitoring.  
HP7568    |   19 February 2021

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