Immunization Record Date of birth: Apr 14, 2019
Mahlet Sara Achamyeleh Ontario Health Card Number: ON 8761 433 419 TN
Routine Immunizations
Vaccine brand name
Age Date and lot number
1m 2019/06/11 X X X X X Pediacel C5424CA
1m 2019/06/11 X Prevnar 13 X52474
3m 2019/08/09 X X X X X Pediacel C5443AA
6m 2019/10/24 X X X X X Pediacel C5460AA
6m 2019/10/24 X ...e Quad 2019-2020 UJ234AB
12m 2020/04/17 X Prevnar 13 AR4648
12m 2020/04/17 X Menjugate AMCA42Dz
12m 2020/04/17 X X X MMR S013685
15m 2020/07/28 X Varilrix AVARC062AA
18m 2020/11/06 X X X X X Pediacel C5629AA
4 2023/10/16 X X X X Adacel-Polio W036278
Please ask your health care provider about recommendations for the meningococcal, pneumococcal and varicella (chicken pox)
vaccines for specific age groups.
Other Immunizations Tuberculosis
TB skin test result
Date Vaccine
(yyyy-mm-dd) Date given Date read Induration size Interpretation
(yyyy-mm-dd) (yyyy-mm-dd) (mm) (pos/neg)
2019/06/11 Rotateq R019982
2019/08/09 Prevnar 13 (PF) X57043
2019/08/09 RotaTeq Vaccine R026342
2019/10/24 Rotateq
2023/10/16 MMR-V W036278
This is your personal immunization record.
Please bring this card to all immunization
appointments: your local public health unit requires
this information when your child goes to school or
Contraindications to Immunizations daycare.
... Daisy Moores Medicine Professional Corporation
Issuing agency
