= Invalid Dose. CDPHE minimum age/interval not met.

= Dose determined invalid by provider

Colorado Immunization Record
Vaccine/Vacuna Date Given Doctor or Clinic Date Next Due
Official Document Dada en la Doctor o Clinica Proxima vacuna
Fecha MM/DD/YYYY
MM/DD/YYYY
Registro de Inmunizacion
DTaP / TD / Tdap
Documento Oficial 1 11/16/2021
2
Your child must comply with Colorado's immunization law to be enrolled in Polio
school. Retain this document as proof of immunization. 1
Su niño/a debe cumplir con la ley de inmunización de Colorado para poder
inscribirse en la escuela. Guarde este documento como prueba de Hib
vacunas. 1

For appointment or information, contact your local county health Pneumococcal

department or your physician's office. 1 05/06/2045

A vaccination health record helps you and your healthcare provider keep 2
your/your child's vaccinations on schedule. If you move or change Rotavirus
providers, having an accurate record might prevent you/your child from
repeating vaccinations you have already had. A shot record should be 1
started when you receive your first vaccination and updated with each Hep A
vaccination visit. Bring this record to every visit.
1
If you have questions or need to know where you can get immunizations, Hep B
call the Colorado HELP Line at 1-877-462-2911.
1
Colorado Immunization Section MMR
4300 Cherry Creek Drive South
Denver, CO 80246 1 MMR 08/31/2021 CW439
2
Present this record at each medical visit.
Presente este documento durante sus visitas medicas. Varicella (CPOX)
1 11/16/2021
Name/Nombre: VINOD CHANDRASHEKAR (4008399)
2
Date of Birth/Fecha de Nacimiento: 05/06/1980 Meningococcal
1
HPV
Vaccine Reactions / Reacciones contra Vacunas:
1
COVID-19
1 COVID-19 mRNA (PFR) 05/01/2021 CPCM
2 COVID-19 mRNA (PFR) 04/10/2021 CPCM
Comments
3
Date Note Influenza
1 Influenza, MDCK Quad PF 10/09/2019 WLG151 11/16/2021
2 Influenza, P-Free 10/23/2013 R03
Vaccines Refused 3
Date Note Travel
1

Vaccine/Vacuna Date Given Doctor or Clinic Date Next Due

Dada en la Doctor o Clinica Proxima vacuna
Fecha MM/DD/YYYY
MM/DD/YYYY

Other
1
2
3
4
5
6

Print Date 11/16/2021 9:05:45AM Page 1 of 1