1.2 KiB
1.2 KiB
type, category, person, date, provider, source
| type | category | person | date | provider | source |
|---|---|---|---|---|---|
| vaccination-record | covid-19 | Yanxin Lu | 2021-04-15 | Forum | 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.