Desert Valley Pediatrics - Buckeye 02/06/2025
4161 N Pioneer Drive Suite 101 Page 1 of 6
(623) 877-7337
Immunization Report
Patient Name & Address:
DOB: 2/5/2021
Bailey Markel
Sex: Female
5519 N 187th Ln
Patient ID: 210561
Litchfield Park AZ 85340
(480) 216-4357 Provider: Cantu RN FNP-C, Kayla
IMMUNIZATION
Vaccination Group: COVID-19
Series: 3
Vaccination: Moderna COVID-19 Vac 6m-11y Intramuscular Suspension 25 MCG/0.25ML
Administered Date: 02/15/2024 10:48 AM
Dose/Route/Site : 0.25 / mL / Right Thigh
Mfr/Lot#/[Link]: Moderna US, Inc. AU5556B 08/06/2024
Vaccination Group: COVID-19
Series: 1
Vaccination: Moderna COVID-19 Vac 6m-11y Single Dose Syringe 25 MCG/0.25ML
Administered Date: 02/06/2025 12:20 PM
Dose/Route/Site : 0.25 / mL / Left Deltoid
Mfr/Lot#/[Link]: Moderna US, Inc. 3044211 06/23/2025
Vaccination Group: COVID-19
Series: 1
Vaccination: Pfizer COVID-19 Vac-TriS 6m-4y Intramuscular Suspension 3 MCG/0.2ML
Administered Date: 11/08/2022 09:54 AM
Dose/Route/Site : 0.2 / mL / Left Thigh
Mfr/Lot#/[Link]: Pfizer, Inc FT9142 11/16/2022
Vaccination Group: COVID-19
Series: 2
Vaccination: Pfizer COVID-19 Vac-TriS 6m-4y Intramuscular Suspension 3 MCG/0.2ML
Administered Date: 04/06/2023 04:05 PM
Dose/Route/Site : 0.2 / mL / Left Thigh
Mfr/Lot#/[Link]: Pfizer, Inc FX5095 06/07/2023
Vaccination Group: DTaP
Series: 4
Vaccination: Infanrix Intramuscular Suspension 25-58-10
Administered Date: 05/16/2022 04:41 PM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline 7KM94 06/10/2023
Vaccination Group: DTaP
Series: 5
Vaccination: Kinrix Intramuscular Suspension Prefilled Syringe 0.5 ML
Administered Date: 02/06/2025 12:19 PM
Dose/Route/Site : 0.5 / mL / Right Deltoid
Mfr/Lot#/[Link]: GlaxoSmithKline 5G23D 08/21/2026
Desert Valley Pediatrics - Buckeye 02/06/2025
4161 N Pioneer Drive Suite 101 Page 2 of 6
(623) 877-7337
Immunization Report
Vaccination Group: DTaP
Series: 1
Vaccination: Pediarix Intramuscular Suspension
Administered Date: 04/12/2021 12:00 AM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline T4Y35 11/28/2022
Comments: Vaccine administered in office. PVT stock used for this Not-VFC Eligible patient.
Vaccination Group: DTaP
Series: 2
Vaccination: Pediarix Intramuscular Suspension
Administered Date: 06/14/2021 10:49 AM
Dose/Route/Site : 0.5 / mL / Right Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline 7P2Y3 04/08/2023
Vaccination Group: DTaP
Series: 3
Vaccination: Pediarix Intramuscular Suspension
Administered Date: 08/09/2021 09:58 AM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline 7P2Y3 04/08/2023
Vaccination Group: Hepatitis A
Series: 1
Vaccination: Havrix Intramuscular Suspension 720 EL U/0.5ML
Administered Date: 02/24/2022 12:11 PM
Dose/Route/Site : 0.5 / mL / Right Deltoid
Mfr/Lot#/[Link]: GlaxoSmithKline EP47E 02/06/2023
Vaccination Group: Hepatitis A
Series: 2
Vaccination: Havrix Intramuscular Suspension 720 EL U/0.5ML
Administered Date: 12/15/2022 03:29 PM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline 3397T 11/30/2023
Vaccination Group: Hepatitis B
Series: 1
Vaccination: Pediarix Intramuscular Suspension
Administered Date: 04/12/2021 12:00 AM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline T4Y35 11/28/2022
Comments: Vaccine administered in office. PVT stock used for this Not-VFC Eligible patient.
Vaccination Group: Hepatitis B
Series: 2
Vaccination: Pediarix Intramuscular Suspension
Administered Date: 06/14/2021 10:49 AM
Dose/Route/Site : 0.5 / mL / Right Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline 7P2Y3 04/08/2023
Desert Valley Pediatrics - Buckeye 02/06/2025
4161 N Pioneer Drive Suite 101 Page 3 of 6
(623) 877-7337
Immunization Report
Vaccination Group: Hepatitis B
Series: 3
Vaccination: Pediarix Intramuscular Suspension
Administered Date: 08/09/2021 09:58 AM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline 7P2Y3 04/08/2023
Vaccination Group: Hepatitis B
Series: 1
Vaccination: Unspecified Formulation
Administered Date: 02/05/2021 12:00 AM
Dose/Route/Site : / /
Mfr/Lot#/[Link]:
Vaccination Group: Hib
Series: 1
Vaccination: Pedvax HIB Intramuscular Suspension 7.5 MCG/0.5ML
Administered Date: 04/12/2021 12:00 AM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: Merck & Co., Inc. T026960 03/17/2023
Comments: Vaccine administered in office. PVT stock used for this Not-VFC Eligible patient.
Vaccination Group: Hib
Series: 2
Vaccination: Pedvax HIB Intramuscular Suspension 7.5 MCG/0.5ML
Administered Date: 06/14/2021 10:50 AM
Dose/Route/Site : 0.5 / mL / Right Thigh
Mfr/Lot#/[Link]: Merck & Co., Inc. T005735 06/12/2022
Vaccination Group: Hib
Series: 3
Vaccination: Pedvax HIB Intramuscular Suspension 7.5 MCG/0.5ML
Administered Date: 05/16/2022 04:41 PM
Dose/Route/Site : 0.5 / mL / Right Thigh
Mfr/Lot#/[Link]: Merck & Co., Inc. U024489 11/02/2023
Vaccination Group: Influenza
Series: 5
Vaccination: Fluarix Intramuscular Suspension Prefilled Syringe 0.5 ML
Administered Date: 02/06/2025 12:20 PM
Dose/Route/Site : 0.5 / mL / Left Deltoid
Mfr/Lot#/[Link]: GlaxoSmithKline 37AK2 06/30/2025
Vaccination Group: Influenza
Series: 1
Vaccination: Fluzone Quadrivalent Intramuscular Suspension Prefilled Syringe 0.5 ML
Administered Date: 05/16/2022 04:41 PM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: Sanofi Pasteur UT7411LA 06/30/2022
Desert Valley Pediatrics - Buckeye 02/06/2025
4161 N Pioneer Drive Suite 101 Page 4 of 6
(623) 877-7337
Immunization Report
Vaccination Group: Influenza
Series: 2
Vaccination: Fluzone Quadrivalent Intramuscular Suspension Prefilled Syringe 0.5 ML
Administered Date: 11/08/2022 09:54 AM
Dose/Route/Site : 0.5 / mL / Right Thigh
Mfr/Lot#/[Link]: Sanofi Pasteur UT7759KA 06/30/2023
Vaccination Group: Influenza
Series: 3
Vaccination: Fluzone Quadrivalent Intramuscular Suspension Prefilled Syringe 0.5 ML
Administered Date: 02/07/2023 09:39 AM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: Sanofi Pasteur UT7695JA 06/30/2023
Vaccination Group: Influenza
Series: 4
Vaccination: Fluzone Quadrivalent Intramuscular Suspension Prefilled Syringe 0.5 ML
Administered Date: 02/15/2024 10:48 AM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: Sanofi Pasteur UT8155NA 06/30/2024
Vaccination Group: MMR
Series: 1
Vaccination: M-M-R II Injection Solution Reconstituted
Administered Date: 02/24/2022 12:21 PM
Dose/Route/Site : 0.5 / mL / Right Arm
Mfr/Lot#/[Link]: Merck & Co., Inc. U006486 02/26/2023
Vaccination Group: MMR
Series: 2
Vaccination: ProQuad Subcutaneous Suspension Reconstituted
Administered Date: 02/06/2025 12:19 PM
Dose/Route/Site : 0.5 / mL / Right Deltoid
Mfr/Lot#/[Link]: Merck & Co., Inc. Y015991 03/23/2026
Vaccination Group: PneumoPCV
Series: 1
Vaccination: Prevnar 13 Intramuscular Suspension
Administered Date: 04/12/2021 12:00 AM
Dose/Route/Site : 0.5 / mL / Right Thigh
Mfr/Lot#/[Link]: Pfizer, Inc DX8303 01/31/2023
Vaccination Group: PneumoPCV
Series: 2
Vaccination: Prevnar 13 Intramuscular Suspension
Administered Date: 06/14/2021 10:50 AM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: Pfizer, Inc DX8303 01/31/2023
Desert Valley Pediatrics - Buckeye 02/06/2025
4161 N Pioneer Drive Suite 101 Page 5 of 6
(623) 877-7337
Immunization Report
Vaccination Group: PneumoPCV
Series: 3
Vaccination: Prevnar 13 Intramuscular Suspension
Administered Date: 08/09/2021 09:59 AM
Dose/Route/Site : 0.5 / mL / Right Thigh
Mfr/Lot#/[Link]: Pfizer, Inc EE3120 05/31/2023
Vaccination Group: PneumoPCV
Series: 4
Vaccination: Prevnar 13 Intramuscular Suspension
Administered Date: 05/16/2022 04:41 PM
Dose/Route/Site : 0.5 / mL / Right Thigh
Mfr/Lot#/[Link]: Pfizer, Inc EY0433 11/30/2023
Vaccination Group: Polio
Series: 5
Vaccination: Kinrix Intramuscular Suspension Prefilled Syringe 0.5 ML
Administered Date: 02/06/2025 12:19 PM
Dose/Route/Site : 0.5 / mL / Right Deltoid
Mfr/Lot#/[Link]: GlaxoSmithKline 5G23D 08/21/2026
Vaccination Group: Polio
Series: 1
Vaccination: Pediarix Intramuscular Suspension
Administered Date: 04/12/2021 12:00 AM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline T4Y35 11/28/2022
Comments: Vaccine administered in office. PVT stock used for this Not-VFC Eligible patient.
Vaccination Group: Polio
Series: 2
Vaccination: Pediarix Intramuscular Suspension
Administered Date: 06/14/2021 10:49 AM
Dose/Route/Site : 0.5 / mL / Right Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline 7P2Y3 04/08/2023
Vaccination Group: Polio
Series: 3
Vaccination: Pediarix Intramuscular Suspension
Administered Date: 08/09/2021 09:58 AM
Dose/Route/Site : 0.5 / mL / Left Thigh
Mfr/Lot#/[Link]: GlaxoSmithKline 7P2Y3 04/08/2023
Vaccination Group: Rotavirus
Series: 1
Vaccination: RotaTeq Oral Solution
Administered Date: 04/12/2021 12:00 AM
Dose/Route/Site : 2 / mL / Oral
Mfr/Lot#/[Link]: Merck & Co., Inc. 1707306 12/26/2021
Comments: Vaccine administered in office. PVT stock used for this Not-VFC Eligible patient.
Desert Valley Pediatrics - Buckeye 02/06/2025
4161 N Pioneer Drive Suite 101 Page 6 of 6
(623) 877-7337
Immunization Report
Vaccination Group: Rotavirus
Series: 2
Vaccination: RotaTeq Oral Solution
Administered Date: 06/14/2021 10:52 AM
Dose/Route/Site : 2 / mL / Oral
Mfr/Lot#/[Link]: Merck & Co., Inc. U007860 01/14/2022
Vaccination Group: Rotavirus
Series: 3
Vaccination: RotaTeq Oral Solution
Administered Date: 08/09/2021 09:59 AM
Dose/Route/Site : 2 / mL / Oral
Mfr/Lot#/[Link]: Merck & Co., Inc. T028131 01/31/2022
Vaccination Group: Varicella
Series: 2
Vaccination: ProQuad Subcutaneous Suspension Reconstituted
Administered Date: 02/06/2025 12:19 PM
Dose/Route/Site : 0.5 / mL / Right Deltoid
Mfr/Lot#/[Link]: Merck & Co., Inc. Y015991 03/23/2026
Vaccination Group: Varicella
Series: 1
Vaccination: Varivax Subcutaneous Injectable 1350 PFU/0.5ML
Administered Date: 02/24/2022 12:22 PM
Dose/Route/Site : 0.5 / mL / Left Arm
Mfr/Lot#/[Link]: Merck & Co., Inc. U024765 08/10/2023
