covid-updates.vistream.tv Open in urlscan Pro
2606:4700:10::ac43:2955  Public Scan

Submitted URL: https://covid-updates.vistream.tv/
Effective URL: https://covid-updates.vistream.tv/register
Submission: On December 19 via automatic, source certstream-suspicious — Scanned from DE

Form analysis 1 forms found in the DOM

POST

<form action="" id="register_form" method="post">
  <!-- [FIRST NAME] -->
  <div class="form-group">
    <label for="first_name" class="register-label">Primer nombre</label>
    <input class="form-control form-card__input" type="text" placeholder="" id="first_name" value="" readonly="" name="first_name" required="">
  </div>
  <!-- [FIRST NAME] -->
  <!-- [LAST NAME] -->
  <div class="form-group">
    <label for="last_name" class="register-label">Apellido</label>
    <input class="form-control form-card__input" type="text" placeholder="" id="last_name" value="" readonly="" name="last_name" required="">
  </div>
  <!-- [LAST NAME] -->
  <!-- [SELECT SPECIALITY] -->
  <div class="form-group">
    <label for="speciality" class="register-label">Especialidad</label>
    <input type="text" class="form-control form-card__input" name="speciality" id="speciality" value="" readonly="">
    <!--<select class="form-control form-card__input" name="speciality" id="speciality" required>-->
    <!--    <option value="" disabled selected>Seleccione su especialidad</option>-->
    <!-- <option value="cardiology">Cardiology</option><option value="clinical_officer">Clinical Officer</option><option value="dermatology">Dermatology</option><option value="diabetology">Diabetology</option><option value="ear_nose_throat">Ear, Nose & Throat</option><option value="emergency_medicine">Emergency Medicine</option><option value="endocrinology">Endocrinology</option><option value="family_medicine">Family Medicine</option><option value="gastroenterology">Gastroenterology</option><option value="general_practitioner">General Practitioner</option><option value="geriatrics">Geriatrics</option><option value="gynae">Gynecologist</option><option value="haematology">Haematology</option><option value="infectious_disease">Infectious Disease</option><option value="internal_medicine">Internal Medicine</option><option value="microbiologists">Microbiologists</option><option value="nephrology">Nephrology</option><option value="neurology">Neurology</option><option value="nurse">Nurse</option><option value="occupational_medicine">Occupational Medicine</option><option value="oncology">Oncology</option><option value="ophthalmology">Ophthalmology</option><option value="optometrist">Optometrist</option><option value="orthopaedics">Orthopaedics</option><option value="paediatrics">Paediatrics</option><option value="pharmaceutical_technologist">Pharmaceutical Technologist</option><option value="pharmacist">Pharmacist</option><option value="psychiatry">Psychiatry</option><option value="radiology">Radiology</option><option value="rehabilitation_medicine">Rehabilitation Medicine</option><option value="resident">Resident</option><option value="respiratory">Respiratory</option><option value="rheumatology">Rheumatology</option><option value="surgery">Surgery</option><option value="urology">Urology</option><option value="other">Other</option>-->
    <!--</select>-->
  </div>
  <!-- [SELECT SPECIALITY] -->
  <!-- [OTHER SPECIALTY] -->
  <!--<div class="form-group" id="otherspeciality" style="display: none;">-->
  <!--   <label for="extra2" class="register-label">Please specify</label>-->
  <!--  <input class="form-control form-card__input" type="text" placeholder="" id="extra2"-->
  <!--    name="extra2" required />-->
  <!--</div>-->
  <!-- [OTHER SPECIALTY] -->
  <!-- [Hospital/Institution] -->
  <!--<div class="form-group">-->
  <!-- <label for="affiliation" class="register-label">Affiliation/Hospital</label>-->
  <!-- <input class="form-control form-card__input" name="affiliation" id="affiliation" placeholder="" required></input>-->
  <!-- </div>-->
  <!-- [Hospital/Institution] -->
  <!--[SELECT LANGUAGE] -->
  <div class="form-group">
    <label for="country" class="register-label">Idioma</label>
    <select class="required form-control form-card__input" name="language" id="language" required="">
      <option value="" selected="" disabled="">Idioma</option>
      <option value="Spanish">Spanish</option>
      <option value="English">English</option>
      <option value="Italian">Italian</option>
      <option value="Portuguese">Portuguese</option>
      <option value="French">French</option>
      <option value="Turkish">Turkish</option>
      <option value="German">German</option>
      <option value="Japanese">Japanese</option>
      <option value="Chinese">Chinese</option>
    </select>
  </div>
  <!--[SELECT LANGUAGE] -->
  <!--[SELECT COUNTRY] -->
  <div class="form-group">
    <label for="country" class="register-label">País</label>
    <select class="required form-control form-card__input" name="country" id="country" required="">
      <option value="" selected="" disabled="">País</option>
      <option data-id="0" class="dn" value="">Select Country</option>
      <option data-id="1" value="Afghanistan">Afghanistan</option>
      <option data-id="2" value="Albania">Albania</option>
      <option data-id="3" value="Algeria">Algeria</option>
      <option data-id="4" value="American Samoa">American Samoa</option>
      <option data-id="5" value="Andorra">Andorra</option>
      <option data-id="6" value="Angola">Angola</option>
      <option data-id="7" value="Anguilla">Anguilla</option>
      <option data-id="3225" value="Antarctica">Antarctica</option>
      <option data-id="8" value="Antigua &amp; Barbuda">Antigua &amp; Barbuda</option>
      <option data-id="9" value="Argentina">Argentina</option>
      <option data-id="10" value="Armenia">Armenia</option>
      <option data-id="11" value="Aruba">Aruba</option>
      <option data-id="12" value="Australia">Australia</option>
      <option data-id="13" value="Austria">Austria</option>
      <option data-id="14" value="Azerbaijan">Azerbaijan</option>
      <option data-id="15" value="Bahamas">Bahamas</option>
      <option data-id="16" value="Bahrain">Bahrain</option>
      <option data-id="17" value="Bangladesh">Bangladesh</option>
      <option data-id="18" value="Barbados">Barbados</option>
      <option data-id="19" value="Belarus">Belarus</option>
      <option data-id="20" value="Belgium">Belgium</option>
      <option data-id="21" value="Belize">Belize</option>
      <option data-id="22" value="Benin">Benin</option>
      <option data-id="23" value="Bermuda">Bermuda</option>
      <option data-id="24" value="Bhutan">Bhutan</option>
      <option data-id="25" value="Bolivia">Bolivia</option>
      <option data-id="26" value="Bonaire">Bonaire</option>
      <option data-id="27" value="Bosnia &amp; Herzegovina">Bosnia &amp; Herzegovina</option>
      <option data-id="28" value="Botswana">Botswana</option>
      <option data-id="29" value="Brazil">Brazil</option>
      <option data-id="30" value="British Indian Ocean Ter">British Indian Ocean Ter</option>
      <option data-id="31" value="Brunei">Brunei</option>
      <option data-id="32" value="Bulgaria">Bulgaria</option>
      <option data-id="33" value="Burkina Faso">Burkina Faso</option>
      <option data-id="34" value="Burundi">Burundi</option>
      <option data-id="35" value="Cambodia">Cambodia</option>
      <option data-id="36" value="Cameroon">Cameroon</option>
      <option data-id="37" value="Canada">Canada</option>
      <option data-id="38" value="Canary Islands">Canary Islands</option>
      <option data-id="39" value="Cape Verde">Cape Verde</option>
      <option data-id="40" value="Cayman Islands">Cayman Islands</option>
      <option data-id="41" value="Central African Republic">Central African Republic</option>
      <option data-id="42" value="Chad">Chad</option>
      <option data-id="43" value="Channel Islands">Channel Islands</option>
      <option data-id="44" value="Chile">Chile</option>
      <option data-id="45" value="China">China</option>
      <option data-id="46" value="Christmas Island">Christmas Island</option>
      <option data-id="47" value="Cocos Island">Cocos Island</option>
      <option data-id="48" value="Colombia">Colombia</option>
      <option data-id="49" value="Comoros">Comoros</option>
      <option data-id="50" value="Congo">Congo</option>
      <option data-id="51" value="Cook Islands">Cook Islands</option>
      <option data-id="52" value="Costa Rica">Costa Rica</option>
      <option data-id="53" value="Cote D'Ivoire">Cote D'Ivoire</option>
      <option data-id="54" value="Croatia">Croatia</option>
      <option data-id="55" value="Cuba">Cuba</option>
      <option data-id="56" value="Curacao">Curacao</option>
      <option data-id="57" value="Cyprus">Cyprus</option>
      <option data-id="58" value="Czech Republic">Czech Republic</option>
      <option data-id="59" value="Denmark">Denmark</option>
      <option data-id="60" value="Djibouti">Djibouti</option>
      <option data-id="61" value="Dominica">Dominica</option>
      <option data-id="62" value="Dominican Republic">Dominican Republic</option>
      <option data-id="63" value="East Timor">East Timor</option>
      <option data-id="64" value="Ecuador">Ecuador</option>
      <option data-id="65" value="Egypt">Egypt</option>
      <option data-id="66" value="El Salvador">El Salvador</option>
      <option data-id="67" value="Equatorial Guinea">Equatorial Guinea</option>
      <option data-id="68" value="Eritrea">Eritrea</option>
      <option data-id="69" value="Estonia">Estonia</option>
      <option data-id="70" value="Ethiopia">Ethiopia</option>
      <option data-id="71" value="Falkland Islands">Falkland Islands</option>
      <option data-id="72" value="Faroe Islands">Faroe Islands</option>
      <option data-id="73" value="Fiji">Fiji</option>
      <option data-id="74" value="Finland">Finland</option>
      <option data-id="75" value="France">France</option>
      <option data-id="76" value="French Guiana">French Guiana</option>
      <option data-id="77" value="French Polynesia">French Polynesia</option>
      <option data-id="78" value="French Southern Ter">French Southern Ter</option>
      <option data-id="79" value="Gabon">Gabon</option>
      <option data-id="80" value="Gambia">Gambia</option>
      <option data-id="81" value="Georgia">Georgia</option>
      <option data-id="82" value="Germany">Germany</option>
      <option data-id="83" value="Ghana">Ghana</option>
      <option data-id="84" value="Gibraltar">Gibraltar</option>
      <option data-id="85" value="Great Britain">Great Britain</option>
      <option data-id="86" value="Greece">Greece</option>
      <option data-id="87" value="Greenland">Greenland</option>
      <option data-id="88" value="Grenada">Grenada</option>
      <option data-id="89" value="Guadeloupe">Guadeloupe</option>
      <option data-id="90" value="Guam">Guam</option>
      <option data-id="91" value="Guatemala">Guatemala</option>
      <option data-id="92" value="Guinea">Guinea</option>
      <option data-id="93" value="Guyana">Guyana</option>
      <option data-id="94" value="Haiti">Haiti</option>
      <option data-id="95" value="Hawaii">Hawaii</option>
      <option data-id="96" value="Honduras">Honduras</option>
      <option data-id="97" value="Hong Kong">Hong Kong</option>
      <option data-id="98" value="Hungary">Hungary</option>
      <option data-id="99" value="Iceland">Iceland</option>
      <option data-id="100" value="India">India</option>
      <option data-id="102" value="Indo China">Indo China</option>
      <option data-id="101" value="Indonesia">Indonesia</option>
      <option data-id="103" value="Iran">Iran</option>
      <option data-id="104" value="Iraq">Iraq</option>
      <option data-id="105" value="Ireland">Ireland</option>
      <option data-id="106" value="Isle of Man">Isle of Man</option>
      <option data-id="107" value="Israel">Israel</option>
      <option data-id="108" value="Italy">Italy</option>
      <option data-id="109" value="Jamaica">Jamaica</option>
      <option data-id="110" value="Japan">Japan</option>
      <option data-id="111" value="Jordan">Jordan</option>
      <option data-id="112" value="Kazakhstan">Kazakhstan</option>
      <option data-id="113" value="Kenya">Kenya</option>
      <option data-id="114" value="Kiribati">Kiribati</option>
      <option data-id="115" value="Korea North">Korea North</option>
      <option data-id="116" value="South Korea">Korea South</option>
      <option data-id="117" value="Kuwait">Kuwait</option>
      <option data-id="118" value="Kyrgyzstan">Kyrgyzstan</option>
      <option data-id="119" value="Laos">Laos</option>
      <option data-id="120" value="Latvia">Latvia</option>
      <option data-id="121" value="Lebanon">Lebanon</option>
      <option data-id="122" value="Lesotho">Lesotho</option>
      <option data-id="123" value="Liberia">Liberia</option>
      <option data-id="124" value="Libya">Libya</option>
      <option data-id="125" value="Liechtenstein">Liechtenstein</option>
      <option data-id="126" value="Lithuania">Lithuania</option>
      <option data-id="127" value="Luxembourg">Luxembourg</option>
      <option data-id="128" value="Macau">Macau</option>
      <option data-id="129" value="Macedonia">Macedonia</option>
      <option data-id="130" value="Madagascar">Madagascar</option>
      <option data-id="132" value="Malawi">Malawi</option>
      <option data-id="131" value="Malaysia">Malaysia</option>
      <option data-id="133" value="Maldives">Maldives</option>
      <option data-id="134" value="Mali">Mali</option>
      <option data-id="135" value="Malta">Malta</option>
      <option data-id="136" value="Marshall Islands">Marshall Islands</option>
      <option data-id="137" value="Martinique">Martinique</option>
      <option data-id="138" value="Mauritania">Mauritania</option>
      <option data-id="139" value="Mauritius">Mauritius</option>
      <option data-id="140" value="Mayotte">Mayotte</option>
      <option data-id="141" value="Mexico">Mexico</option>
      <option data-id="142" value="Midway Islands">Midway Islands</option>
      <option data-id="143" value="Moldova">Moldova</option>
      <option data-id="144" value="Monaco">Monaco</option>
      <option data-id="145" value="Mongolia">Mongolia</option>
      <option data-id="146" value="Montserrat">Montserrat</option>
      <option data-id="147" value="Morocco">Morocco</option>
      <option data-id="148" value="Mozambique">Mozambique</option>
      <option data-id="149" value="Myanmar">Myanmar</option>
      <option data-id="150" value="Namibia">Namibia</option>
      <option data-id="151" value="Nauru">Nauru</option>
      <option data-id="152" value="Nepal">Nepal</option>
      <option data-id="153" value="Netherland Antilles">Netherland Antilles</option>
      <option data-id="154" value="Netherlands (Holland, Europe)">Netherlands (Holland, Europe)</option>
      <option data-id="155" value="Nevis">Nevis</option>
      <option data-id="156" value="New Caledonia">New Caledonia</option>
      <option data-id="157" value="New Zealand">New Zealand</option>
      <option data-id="158" value="Nicaragua">Nicaragua</option>
      <option data-id="159" value="Niger">Niger</option>
      <option data-id="160" value="Nigeria">Nigeria</option>
      <option data-id="161" value="Niue">Niue</option>
      <option data-id="162" value="Norfolk Island">Norfolk Island</option>
      <option data-id="163" value="Norway">Norway</option>
      <option data-id="164" value="Oman">Oman</option>
      <option data-id="165" value="Pakistan">Pakistan</option>
      <option data-id="166" value="Palau Island">Palau Island</option>
      <option data-id="167" value="Palestine">Palestine</option>
      <option data-id="168" value="Panama">Panama</option>
      <option data-id="169" value="Papua New Guinea">Papua New Guinea</option>
      <option data-id="170" value="Paraguay">Paraguay</option>
      <option data-id="171" value="Peru">Peru</option>
      <option data-id="172" value="Philippines">Philippines</option>
      <option data-id="173" value="Pitcairn Island">Pitcairn Island</option>
      <option data-id="174" value="Poland">Poland</option>
      <option data-id="175" value="Portugal">Portugal</option>
      <option data-id="176" value="Puerto Rico">Puerto Rico</option>
      <option data-id="177" value="Qatar">Qatar</option>
      <option data-id="178" value="Republic of Montenegro">Republic of Montenegro</option>
      <option data-id="179" value="Republic of Serbia">Republic of Serbia</option>
      <option data-id="180" value="Reunion">Reunion</option>
      <option data-id="181" value="Romania">Romania</option>
      <option data-id="182" value="Russia">Russia</option>
      <option data-id="183" value="Rwanda">Rwanda</option>
      <option data-id="192" value="Saipan">Saipan</option>
      <option data-id="193" value="Samoa">Samoa</option>
      <option data-id="194" value="Samoa American">Samoa American</option>
      <option data-id="195" value="San Marino">San Marino</option>
      <option data-id="196" value="Sao Tome &amp; Principe">Sao Tome &amp; Principe</option>
      <option data-id="197" value="Saudi Arabia">Saudi Arabia</option>
      <option data-id="198" value="Senegal">Senegal</option>
      <option data-id="199" value="Serbia">Serbia</option>
      <option data-id="200" value="Seychelles">Seychelles</option>
      <option data-id="201" value="Sierra Leone">Sierra Leone</option>
      <option data-id="202" value="Singapore">Singapore</option>
      <option data-id="203" value="Slovakia">Slovakia</option>
      <option data-id="204" value="Slovenia">Slovenia</option>
      <option data-id="205" value="Solomon Islands">Solomon Islands</option>
      <option data-id="206" value="Somalia">Somalia</option>
      <option data-id="207" value="South Africa">South Africa</option>
      <option data-id="208" value="Spain">Spain</option>
      <option data-id="209" value="Sri Lanka">Sri Lanka</option>
      <option data-id="184" value="St Barthelemy">St Barthelemy</option>
      <option data-id="185" value="St Eustatius">St Eustatius</option>
      <option data-id="186" value="St Helena">St Helena</option>
      <option data-id="187" value="St Kitts-Nevis">St Kitts-Nevis</option>
      <option data-id="188" value="St Lucia">St Lucia</option>
      <option data-id="189" value="St Maarten">St Maarten</option>
      <option data-id="190" value="St Pierre &amp; Miquelon">St Pierre &amp; Miquelon</option>
      <option data-id="191" value="St Vincent &amp; Grenadines">St Vincent &amp; Grenadines</option>
      <option data-id="210" value="Sudan">Sudan</option>
      <option data-id="211" value="Suriname">Suriname</option>
      <option data-id="212" value="Swaziland">Swaziland</option>
      <option data-id="213" value="Sweden">Sweden</option>
      <option data-id="214" value="Switzerland">Switzerland</option>
      <option data-id="215" value="Syria">Syria</option>
      <option data-id="216" value="Tahiti">Tahiti</option>
      <option data-id="217" value="Taiwan">Taiwan</option>
      <option data-id="218" value="Tajikistan">Tajikistan</option>
      <option data-id="219" value="Tanzania">Tanzania</option>
      <option data-id="220" value="Thailand">Thailand</option>
      <option data-id="221" value="Togo">Togo</option>
      <option data-id="222" value="Tokelau">Tokelau</option>
      <option data-id="223" value="Tonga">Tonga</option>
      <option data-id="224" value="Trinidad &amp; Tobago">Trinidad &amp; Tobago</option>
      <option data-id="225" value="Tunisia">Tunisia</option>
      <option data-id="226" value="Turkey">Turkey</option>
      <option data-id="227" value="Turkmenistan">Turkmenistan</option>
      <option data-id="228" value="Turks &amp; Caicos Is">Turks &amp; Caicos Is</option>
      <option data-id="229" value="Tuvalu">Tuvalu</option>
      <option data-id="230" value="Uganda">Uganda</option>
      <option data-id="231" value="Ukraine">Ukraine</option>
      <option data-id="232" value="United Arab Emirates">United Arab Emirates</option>
      <option data-id="233" value="United Kingdom">United Kingdom</option>
      <option data-id="234" value="United States of America">United States of America</option>
      <option data-id="235" value="Uruguay">Uruguay</option>
      <option data-id="236" value="Uzbekistan">Uzbekistan</option>
      <option data-id="237" value="Vanuatu">Vanuatu</option>
      <option data-id="238" value="Vatican City State">Vatican City State</option>
      <option data-id="239" value="Venezuela">Venezuela</option>
      <option data-id="240" value="Vietnam">Vietnam</option>
      <option data-id="241" value="Virgin Islands (Brit)">Virgin Islands (Brit)</option>
      <option data-id="242" value="Virgin Islands (USA)">Virgin Islands (USA)</option>
      <option data-id="243" value="Wake Island">Wake Island</option>
      <option data-id="244" value="Wallis &amp; Futana Is">Wallis &amp; Futana Is</option>
      <option data-id="245" value="Yemen">Yemen</option>
      <option data-id="246" value="Zaire">Zaire</option>
      <option data-id="247" value="Zambia">Zambia</option>
      <option data-id="248" value="Zimbabwe">Zimbabwe</option>
    </select>
  </div>
  <!--[SELECT COUNTRY] -->
  <!-- Phone NUMBER -->
  <div class="form-group dn country_saudi_arabia required" style="display: none;">
    <label for="email" class="login-label">Afiliación/Hospital</label>
    <!--<small class="dn">Este campo no puede estar vacío</small><small-->
    <!-- class="animated dn">Introduzca un e-mail válido</small>-->
    <input id="extra6" name="extra6" type="text" maxlength="50" class="form-control login-form">
  </div>
  <!-- Phone NUMBER -->
  <!-- IQAMA  NUMBER -->
  <div class="form-group dn country_saudi_arabia required" style="display: none;">
    <label for="email" class="login-label">SCFHS Number</label>
    <!--<small class="dn">Este campo no puede estar vacío</small><small-->
    <!-- class="animated dn">Introduzca un e-mail válido</small>-->
    <input id="extra7" name="extra7" type="text" maxlength="50" class="form-control login-form">
  </div>
  <!-- IQAMA  NUMBER -->
  <!-- [EMAIL] -->
  <div class="form-group">
    <label for="email" class="register-label">Correo electrónico</label>
    <input class="form-control form-card__input" type="email" placeholder="" id="email" name="email" value="" readonly="" required="">
  </div>
  <!-- [EMAIL] -->
  <!-- [Healthcare Professional ID] -->
  <!--<div class="form-group">-->
  <!-- <label for="extra3" class="register-label" id="change-label-info">Healthcare Professional ID</label>-->
  <!-- <input class="form-control form-card__input" name="extra3" id="extra3" placeholder="" required value="" >-->
  <!-- </div>-->
  <!-- [Healthcare Professional ID] -->
  <div class="form-group">
    <label for="hcp_uuid" class="register-label">GRV ID</label>
    <input class="form-control form-card__input not_required" id="extra5" name="extra5" value="" readonly="">
    <!--<img src="/file/image/icons/icon-location.png" alt="Icon" class="form-card__icon">-->
  </div>
  <!-- [CHECKBOXS] -->
  <div class="form-card__checkbox">
    <!-- [FIRST CHECKBOX] -->
    <div class="form-group" id="first-checkbox">
      <label class="checkbox-label register-label" for="cb-first">
        <input id="cb-first" name="cb-first" type="checkbox" class="click-checkbox-3" value="1" required="">
        <span class="checkbox-custom rectangular"></span>
        <span class="form-card__text"> Confirmo que soy un profesional de la salud </span>
      </label>
    </div>
    <!-- [FIRST CHECKBOX] -->
    <!-- [SECOND CHECKBOX] -->
    <div class="form-group" id="second-checkbox">
      <label class="checkbox-label register-label" for="cb-second">
        <input id="cb-second" name="cb-second" type="checkbox" class="click-checkbox-3" value="1" required="">
        <span class="checkbox-custom rectangular"></span>
        <span class="form-card__text">
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as well as information obtained in the course of various Pfizer programs and
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the authorization which I confer herein. My express consent shall continue for
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correction of my personal information, as well as my right to lodge a complaint
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I further understand that Pfizer and its authorized affiliates or authorized
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as long as necessary (i) for the fulfillment of the Purposes, (ii) for the
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Finally, I hereby confirm and provide consent for Pfizer, its employees,
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Date of preparation: January 2022