2. Do you have symptoms of COVID-19, for example fever, new onset of cough or worsening of chronic cough, shortness of breath, difficulty breathing, sore throat, difficulty swallowing, decrease or loss of smell or taste, chills, headaches, unexplained tiredness/malaise/muscle aches, nausea/vomiting, diarrhea or abdominal pain, pink eye, or runny nose or nasal congestion without other known cause? a. If you are over 70 years of age, have you experienced an unexplained or increased number of falls, acute functional decline, worsening of chronic conditions or delirium?
3. Are you or could you be pregnant?
4. Are you currently breastfeeding?
5. Do you have a bleeding disorder or are taking medications that could affect blood clotting?
6. Are you immunosuppressed due to disease or treatment of an autoimmune disorder?
7. Are you allergic to polyethylene glycol which is contained in the vaccine? (It can be found in some cosmetics, skin care products, medications including laxatives and cough syrups, and some food and drinks.)
8. Have you previously had an allergic reaction to any vaccine or any component of the Pfizer-BioNTech vaccine?
9. Have you previously experienced a serious allergic reaction, including anaphylaxis, to another vaccine, drug or food?
10. Have you ever fainted after receiving vaccines or medical procedures before?
11. Have you received another vaccine (not a COVID-19 vaccine) in the past 14 days?
12. Do you have any questions?