---
type: vaccination-record
category: covid-19
person: Yanxin Lu
date: 2021-04-15
provider: Forum
source: lu_covid_vaccine.pdf
---

# COVID-19 Vaccination Record Card

| Field | Value |
|---|---|
| **Last Name** | Lu |
| **First Name** | Yanxin |
| **MI** | |
| **Date of Birth** | 10/17/1989 |
| **Patient Number** | |

## Vaccination Details

| | 1st Dose COVID-19 | 2nd Dose COVID-19 |
|---|---|---|
| **Product Name/Manufacturer** | Pfizer | Pfizer |
| **Lot Number** | EW0161 | EW0173 |
| **Expiration** | 07/31/2021 | 08/31/2021 |
| **Date** | 04/15/2021 | 05/06/2021 |
| **Healthcare Professional / Clinic Site** | Forum | Forum |

## Reminder (Back of Card)

| Field | Value |
|---|---|
| **Vaccine** | Pfizer |
| **Return Date (2nd Dose)** | 05/06/21 |

## Notes

- Two physical cards are present in the PDF (pages 1-2 and pages 3-4). Both belong to the same person and contain consistent information.
- Card 1 (page 1) shows the 1st dose entry; the back (page 2) shows the 2nd dose reminder date of 05/06/21 and a Pfizer vaccine sticker.
- Card 2 (page 3) shows both 1st and 2nd dose entries filled in; the back (page 4) shows a Pfizer vaccine sticker with blank reminder date fields.