Provisional Certificate for COVID-19 Vaccination - 1st Dose

Beneficiary Details

Beneficiary Name / ಫ ಾನುಭ ಯ ಸರು Madhu

Age / ವಯಸು 23

Gender / ಂಗ Male

ID Verified / ಐ. . ಗುರುತು Aadhaar # XXXXXXXX2020

Unique Health ID (UHID)

Beneficiary Reference ID 16275289434911

Vaccination Details

Vaccine Name / ಲ ಸರು COVISHIELD

Date of Dose / ೂೕ ಾಂಕ 07 Jul 2021 (Batch no. 4121MC018)

Next due date / ಮುಂ ನ ಲ ೕಡುವ ಾಂಕ Between 29 Sep 2021 and 27 Oct 2021

Vaccinated by / ಲ ೕ ದವರು Kokila

Vaccination at / ಲ ಾ ದ ಸಳ PHC THOLAHUNSE Workplace CVC,

Davanagere, Karnataka

“ಔಷ /ಲ ೕಕು,
ೂ ದೃಢ ೕಕು
Together, India will defeat
COVID-19”
- ಪ ಾನಮಂ ನ ೕಂದ ೕ

In case of any adverse events, kindly contact the nearest Public Health Center/
Healthcare Worker/District Immunization Officer/State Helpline No. 1075
ಾವ ೕ ಅಡಪ ಾಮ ಉಂ ಾದ ಸಂದಭ ದ , ದಯ ಟು ಸ ೕಪದ ಾವ ಜ ಕ ಆ ೂೕಗ
ೕಂದ /ಆ ೂೕಗ ಶುಷೂ ಾಯ ಕ / ಾ ಲ ಅ ಾ / ಾಜ ಸ ಾಯ ಾ ಸಂ. 1075
ಸಂಪ

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