Certificate for COVID-19 Vaccination

Partially Vaccinated : 1st Dose

Beneficiary Details

Beneficiary Name / ଲାଭାଥୀ ର ନାମ Asmita Pattanaik

Age / ବୟସ 57

Gender / ଲ Female

ID Verified / ଆଇଡି ସତ ାପିତ େହାଇଛି Aadhaar # XXXXXXXX4056

Unique Health ID (UHID)

Beneficiary Reference ID 14657171676280

Vaccination Details

Vaccine Name / ଟିକା ନାମ COVISHIELD

Date of 1st Dose / ପଥମ େଡାଜର ତାରିଖ 05 Oct 2021 (Batch no. 4121MF007)

Next due date / ପରବ ୀ ଟୀକାକରଣ ତାରିଖ Between 28 Dec 2021 and 25 Jan 2022

Vaccinated by / ଟିକା େଦଉଥବା ବ କି ନାମ Puspanjali Mohapatra

Vaccination at / ଟୀକାକରଣ ସାନ Balarampurgada GP Office, Puri, Odisha

“ଔଷଧ ମ ଏବଂ କେଠାରତା ମ

Together, India will defeat
COVID-19”
- ପଧାନମନୀ ନେର େମାଦି

In case of any adverse events, kindly contact the nearest Public Health Center/
Healthcare Worker/District Immunization Officer/State Helpline No. 1075
େକୗଣସି ପକାର ପତିକୂଳ ଘଟଣା ଘଟିେଲ ଦୟାକରି ନିକଟସ ଜନସାସ େକ / ସାସ େସବା କମୀ / ଜିଲା
ଟୀକାକରଣ ଅଫସର / ରାଜ େହଲଲାଇନ ନମର 1075 ସହିତ େଯାଗାେଯାଗ କର

This certificate can be verified by scanning the QR code at

http://verify.cowin.gov.in