Nevada Immunization Record

Vaccine/Vacuna

Age at Imm.
Edad Cuando
Inm.

Doctor or Clinic
Doctor o Clinica

MM/DD/YYYY

Official Document

DTaP/Td/Tdap

Registro de Inmunizacion
Documento Oficial
Name/Nombre:

Date Given
Dada en la
Fecha

VICTORIA LUNA-MARQUEZ

DTaP-Hep B-IPV

03/06/2014

0Y 2M 6D

FMCUNR

DTaP-IPV/Hib

06/04/2014

0Y 5M 7D

RMG-PEDS

DTaP-IPV/Hib

11/19/2014

0Y 10M 22D

RMG-PEDS

DTaP

07/14/2015

1Y 6M 16D

RMG-PEDS

DTaP-Hep B-IPV

03/06/2014

0Y 2M 6D

FMCUNR

DTaP-IPV/Hib

06/04/2014

0Y 5M 7D

RMG-PEDS

DTaP-IPV/Hib

11/19/2014

0Y 10M 22D

RMG-PEDS

1Y 0M 3D

RMG-PEDS

Polio

Date of Birth/Fecha de Nacimiento: 12/28/2013

Gender/Genero: F
Nevada WebIZ ID#: 2969896

Date of Next Vaccination/Fecha de Proxima Vacuna: 09/01/2016

MMR/Measles
1

MMR

12/31/2014

Hib (PRP-T)

03/06/2014

0Y 2M 6D

FMCUNR

DTaP-IPV/Hib

06/04/2014

0Y 5M 7D

RMG-PEDS

DTaP-IPV/Hib

11/19/2014

0Y 10M 22D

RMG-PEDS

Hib (PRP-T)

04/01/2015

1Y 3M 4D

RMG-PEDS

Hep B, ped/adol

12/28/2013

0Y 0M 0D

RRMC

DTaP-Hep B-IPV

03/06/2014

0Y 2M 6D

FMCUNR

Hep B, ped/adol

11/19/2014

0Y 10M 22D

RMG-PEDS

Hep A, ped/adol

12/31/2014

1Y 0M 3D

RMG-PEDS

Hep A, ped/adol

07/14/2015

1Y 6M 16D

RMG-PEDS

Present this record at each medical visit.

Presente este documento durante sus visitas medicas.

Immunization Provider:
INTER-TRIBAL COUNCIL OF NEVADA WIC
680 GREENBRAE DR, UNIT #222
SPARKS, NV 89431

Hib

HEPB

775-398-4960

Allergies/Precautions/Contraindications
Alergias/Precauciones/Contraindicaciones:

HEPA

Pneumococcal

Vaccine Reactions / Reacciones contra Vacunas:

PCV-13 (Prevnar 13)

03/06/2014

0Y 2M 6D

FMCUNR

PCV-13 (Prevnar 13)

06/04/2014

0Y 5M 7D

RMG-PEDS

PCV-13 (Prevnar 13)

11/19/2014

0Y 10M 22D

RMG-PEDS

PCV-13 (Prevnar 13)

04/01/2015

1Y 3M 4D

RMG-PEDS

Rotavirus (Rotateq)

03/06/2014

0Y 2M 6D

FMCUNR

Rotavirus (Rotateq)

06/04/2014

0Y 5M 7D

RMG-PEDS

1Y 0M 3D

RMG-PEDS

ROTA

Varicella(CPOX)
1

Comments
Date

CPOX (Varicella)

12/31/2014

Other

Note

Meningococcal
1
2

HPV
1
2
3

Date Given
Dada en la
Fecha

Vaccine/Vacuna

MM/DD/YYYY

Age at Imm.
Edad Cuando
Inm.

Doctor or Clinic
Doctor o Clinica

Influenza
1

Influenza Ped Quad PF

02/29/2016

2Y 2M 1D

RMG-PEDS

Influenza Ped Quad PF

12/31/2014

1Y 0M 3D

RMG-PEDS

Influenza Ped Quad PF

11/19/2014

0Y 10M 22D

RMG-PEDS

Print Date 6/21/2016 3:59:30PM

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