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COVID-19 Vaccination Card Dosage Date

Name of
Vaccine Brand Vaccinator Batch No. Lot No.
Please keep this record card, which includes medical information about the vaccines you have received. Seq. (mm/dd/yyyy)
(with signature)
Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong SHM-042093
natanggap.

1st Dosage / /

2nd Dosage / /

MENDOZA, 36021BD
Last Name DEL MUNDO First Name AMIEL Middle Name P Suffix
1st Booster 11/22/2022 PFIZER
CHRISTIAN C.
-
2/28/2023
Address Contact No.
IBABA ST., MAYTALANG II, LUMBAN, LAGUNA 09164391473
Date of Birth Jul 17, 1999 Sex MALE PhilHealth No. Category A1 2nd Booster / /

Health Facility Name AMOSUP MANILA, PHILIPPINES Contact No. +63 (02) 85271116 to 20

Fro n t Ba c k

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