COVID-19 Vaccination Card

Please keep this record card, which includes medical information Card ID no.
about the vaccines you have received 1305921
SANTILLAN JESA TALAID N/A
Last Name First Name M.I. Suffix

Address SAN ISIDRO, 045805000Cainta- Contact No. 9338545640

, 045800000Rizal, REGION IV-A (CAL-
ABARZON),

Date of Birth 09/30/1979 Sex F Philhealth No. N/A Category A3

Dosage Seq. Date Vaccine Manufacturer Batch No. Lot No.

11/19/2021 Moderna 010G21B

1st Dose Schedule

Vaccinator Name: CEASAR JR. ORDANZA

12/17/2021 Moderna 010G21B

2nd Dose Schedule

Vaccinator Name: KIMBERLY C SANTOS

Booster Dose
Schedule
Vaccinator Name:

Health Facility NPF Drive Through Contact No.:

Name(1st Dose):

Health Facility NPF Drive Through Contact No.:

Name(2nd Dose):

Health Facility - Contact No.:

Name(Booster Dose):