type, category, person, date, source
| type |
category |
person |
date |
source |
| medical-record |
vaccination |
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.
