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---
type: medical-record
category: vaccination
person: Lu Yanxin
date: 2021-05-06
source: lu_vaccine_2nd_shot.jpg
---
# COVID-19 Vaccination Record Card — Lu Yanxin
Two cards are shown in this image (original and replacement/updated).
## Card 1 (Top)
| Field | Value |
|-------|-------|
| Last Name | Lu |
| First Name | Yanxin |
| MI | — |
| Date of Birth | 10/17/1989 |
| Patient Number | — |
| Dose | Vaccine | Lot # | EXP | Date | Healthcare Professional or Clinic Site |
|------|---------|-------|-----|------|---------------------------------------|
| 1st Dose COVID-19 | PFIZER COVID-19 VACCINE | EW0161 | 07/31/2021 | 4/15/2021 | FORUM |
| 2nd Dose COVID-19 | — | — | — | — | — |
| Other | — | — | — | — | — |
| Other | — | — | — | — | — |
## Card 2 (Bottom)
| Field | Value |
|-------|-------|
| Last Name | Lu |
| First Name | Yanxin |
| MI | — |
| Date of Birth | 10-17-1989 |
| Patient Number | — |
| Dose | Vaccine | Product Name/Manufacturer | Lot Number | Date | Healthcare Professional or Clinic Site |
|------|---------|--------------------------|------------|------|---------------------------------------|
| 1st Dose COVID-19 | Pfizer | Pfizer | EW0161 | 4/15/21 | Forum |
| 2nd Dose COVID-19 | PFIZER COVID-19 VACCINE | — | EW0173 | 5/6/2021 (EXP: 08/31/2021) | FORUM |
| Other | — | — | — | — | — |
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