(19-‫اﻟﺘﻘﺮﻳﺮ اﻟﻄﺒﻲ ﻟﺘﻄﻌﻴﻢ ﻓﺎﻳﺮوس ﻛﻮروﻧﺎ )ﻛﻮﻓﻴﺪ‬

COVID-19 Vaccine Medical Report

Full Name FATMA ZOHRA GHOULI EPOUSE MAKDAD ‫ﻓﺎ ﻃ ﻤ ﺔ ا ﻟ ﺰ ﻫ ﺮا ء ﻏ ﻮ ﱄ ز و ﺟ ﺔ ﻣ ﻘ ﺪا د‬ ‫اﻻﺳﻢ‬

ID Number 2356923306 2356923306 ‫ر ﻗ ﻢ ا ﻟ ﻬ ﻮﻳ ﺔ‬

Date of birth 12 Aug 1988 1988 ‫ ​ أﻏﺴﻄﺲ‬12 ‫ﺗﺎرﻳﺦ اﳌﻴﻼد‬

Nationality Algeria ‫ا ﻟ ﺠ ﺰ اﺋ ﺮ‬ ‫اﻟ ﺠﻨ ﺴﻴ ﺔ‬

Vaccine Type AstraZeneca (VAXZEVRIA®, COVISHIELD™) ‫أﺳﺘﺮاز ﻳﻨﻴﻜﺎ‬ ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2021-09-23 2021 ‫ ​ ﺳﺒﺘﻤﺒﺮ‬23 ‫اﻟﺘﺎرﻳﺦ‬

Batch Number OutsideKingdom OutsideKingdom ‫ر ﻗ ﻢ اﻟﺘ ﺸ ﻐﻴ ﻠ ﺔ‬

Vaccine Type AstraZeneca (VAXZEVRIA®, COVISHIELD™) ‫أﺳﺘﺮاز ﻳﻨﻴﻜﺎ‬ ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2021-12-14 2021 ‫ ​ دﻳﺴﻤﺒﺮ‬14 ‫اﻟﺘﺎرﻳﺦ‬

Batch Number OutsideKingdom OutsideKingdom ‫ر ﻗ ﻢ اﻟﺘ ﺸ ﻐﻴ ﻠ ﺔ‬

‫ اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬،‫ﺗﻢ إﺻﺪار ﻫﺬا اﻟﺘﻘﺮ ﻳﺮ ﻣﻦ ﻗﺒﻞ وزارة اﻟﺼﺤﺔ‬

‫ﻫﺬا اﻟﺘﻘﺮ ﻳﺮ ﻟﻺﺳﺘﺨﺪام اﻟﻄﺒﻲ ﺧﺎرج اﳌﻤﻠﻜﺔ ﰲ اﻟﺪول اﻟﱵ ﻟﻢ ﺗﺮﺗﺒﻂ إﻟﻜﺘﺮوﻧﻴﺎ ﻣﻊ اﻷﻧﻈﻤﺔ اﻟﺤﻜﻮﻣﻴﺔ ﰲ اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬

This Report has been issued by the Ministry of Health, Kingdom of Saudi Arabia

This report is intended to be used for medical purposes outside the Kingdom of Saudi Arabia, in the countries that are not integrated with
the Kingdom's government systems.

Kindly scan the QR code to vaildate Report No. ‫رﻗﻢ اﻟﺘﻘﺮ ﻳﺮ‬ ‫ﻳﺮﺟﻰ ﻣﺴﺢ اﻟﺒﺎرﻛﻮد ﻟﻠﺘﺤﻘﻖ ﻣﻦ ﺻﺤﺔ‬

this report VCC19012237887 ‫ﻫﺬا اﻟﺘﻘﺮ ﻳﺮ‬

https://VaccineCertificate.sehhaty.sa https://VaccineCertificate.sehhaty.sa

www.moh.gov.sa | 937 | SaudiMOH | MOHPortal | SaudiMOH | Saudi_MOH