type, category, person, date, source
type
category
person
date
source
lab-results
medical
Lu Yanxin
2021-05-06
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
—
—
—
—
—
Scanned by TapScanner.