Immunisation history statement

As at: 12 September 2016

For: AADIT REGMI
Date of birth: 03 May 2012
Immunisation status: up to date

Schedule

Immunisation

Date given

Brand name given

Provider type

2 months

Polio

15 May 2012

Polio Sabin (Oral)

History Form

Hepatitis B
Diphtheria Tetanus Pertussis

13 Jun 2012

Hepatitis B
Triple Antigen

HIB Schedule B
4 months

6 months

Hib Schedule B

Polio
Hepatitis B
Diphtheria Tetanus Pertussis
HIB Schedule B

13 Jun 2012

Polio
Polio
Diphtheria Tetanus Pertussis
Hepatitis B
Diphtheria Tetanus Pertussis

11 Jul 2012
12 Aug 2012

11 Jul 2012

07 Nov 2012
25 Sep 2013

Polio
12 months

18 months

Polio Sabin (Oral)

Hepatitis B
Triple Antigen
Hib Schedule B

History Form

Polio Sabin (Oral)

Polio Sabin (Oral)
Triple Antigen
Hepatitis B
Triple Antigen

History Form

Polio Sabin (Oral)

HIB Schedule B
Measles Mumps Rubella
HIB Schedule B

12 Aug 2012
07 Aug 2013
25 Sep 2013

Hib Schedule B
MMR
Hib Schedule B

History Form

Meningococcal C

05 Jul 2016

NeisVac-C

GP

Varicella

07 Aug 2013

Varicella

History Form

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Schedule

Immunisation
Measles Mumps Rubella

Date given
13 May 2016

Brand name given

MMR II

Provider type
GP

4 years

Diphtheria Tetanus Pertussis Polio

13 May 2016

Infanrix-IPV

GP

Other

Tuberculosis

15 May 2012

BCG

History Form

Hepatitis A

25 Sep 2013

Hepatitis A

Hepatitis A

15 Mar 2014

Hepatitis A

Influenza
Influenza

03 Jun 2016
05 Jul 2016

FluQuadri
Fluarix Tetra

Next immunisation/s due

GP

Date due

This child has received all vaccines required by 5 years of age.

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The Australian Childhood Immunisation Register records vaccinations given to children and young people under 20 years of
age. Immunisations given before 1 January 1996 are not displayed on the statement.
Every effort is made to ensure that the information contained on the Australian Childhood Immunisation Register is correct.
The data is based on information provided by vaccination providers and the accuracy of data is dependent on the quality
and timeliness of information provided.
If an immunisation is missing from this statement and was given more than one month ago, your vaccination provider will
need to send the missing information to the Australian Childhood Immunisation Register. If any of the immunisation details
shown on the statement are not correct, please ask your provider to call us on 1800 653 809 to provide the correct details.
If you have any questions about this statement, please call the Australian Childhood Immunisation Register on the number
above (call charges may apply).

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