• COVID-19 Vaccine Consent Form

    Warning! Completing this form will allow you to schedule an appointment to receive the Moderna COVID-19 vaccine at Hawthorne Pharmacy on 1520A Taylor St, Columbia, SC 29201. If you would like to receive the vaccine at a different Hawthorne Pharmacy location, please click this link to access the store-specific form for your desired Hawthorne location. Thank you!

    The Moderna COVID-19 vaccine is a 2-dose series seperated by 28 days. You will be able to sign up for the second dose during your first dose appointment.

    Moderna COVID-19 vaccine Emergency Use Authorization (https://www.fda.gov/media/144638/download)

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  • Because you have a history of anaphylaxis, please consult your primary care provider before receiving the COVID-19 vaccine at Hawthorne Pharmacy. Thank you!

  • Please consult your OB/GYN before scheduling a COVID-19 vaccine appointment with Hawthorne Pharmacy. Thank you!

  • The Centers for Disease Control and Prevention (CDC) recommends that individuals not receive the COVID-19 vaccine within 90 days of receiving monoclonal antibody therapy. Because of this, Hawthorne Pharmacy cannot administer the vaccine for you at this time. Thank you!

  • The COVID-19 vaccine should routinely be administered alone, with a minimum interval of 14 days before or after administration of any other vaccine. Please be sure to not schedule your COVID-19 vaccine within 14 days of recieving any other vaccine. 

  • The Centers for Disease Control and Prevention (CDC) considers a history of an allergic reaction to polyethylene glycol to be a contraindication to the COVID-19 vaccine. Because of this, you cannot receive your COVID-19 vaccine at Hawthorne Pharmacy.

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