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  • Flu Shot 2021-2022 Record

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    Kamyab Pirouz
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    This document provides a medical activity history for an employee named Kamyab Pirouz from May 2021 to December 2021. It shows that they received their first dose of the Moderna COVID vaccine on 5/08/2021, their second dose on 6/05/2021, and a booster dose on 12/20/2021 from an external provider. Additional medical activities included a negative TB screening, clearance for research animal contact and surveillance, receiving the influenza vaccine, and completing various assessments.

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    This document provides a medical activity history for an employee named Kamyab Pirouz from May 2021 to December 2021. It shows that they received their first dose of the Moderna COVID vaccine on 5/08/2021, their second dose on 6/05/2021, and a booster dose on 12/20/2021 from an external provider. Additional medical activities included a negative TB screening, clearance for research animal contact and surveillance, receiving the influenza vaccine, and completing various assessments.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    8 views1 page

    Flu Shot 2021-2022 Record

    Uploaded by

    Kamyab Pirouz
    This document provides a medical activity history for an employee named Kamyab Pirouz from May 2021 to December 2021. It shows that they received their first dose of the Moderna COVID vaccine on 5/08/2021, their second dose on 6/05/2021, and a booster dose on 12/20/2021 from an external provider. Additional medical activities included a negative TB screening, clearance for research animal contact and surveillance, receiving the influenza vaccine, and completing various assessments.

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    © All Rights Reserved
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    of 1

    Date: 2/28/2022 PHS Occupational Health Services Page: 1

    Employee Medical Activity History


    Reporting All Medical Activity History for Kamyab Pirouz
    Date Company Medical Activity Activity Result Code and Summary Measure 1 Measure 2 Next Due
    5/08/2021 GHC Vaccine: COVID Moderna 1 Dose 1 6/07/2021
    0.5 mL
    Drug Company: Lot: Expiration: Site:
    Clinician: Location Given: External Provider
    6/05/2021 GHC Vaccine: COVID Moderna C Completed
    0.5 mL
    Drug Company: Lot: Expiration: Site:
    Clinician: Location Given: External Provider
    7/09/2021 GHC TB Screening: BAMT - Negative Final
    IU/mL
    Clinician: Location Given: Clinic
    7/09/2021 GHC Research Animal Surveillance L Cleared
    Clinician: Farrah Samadi, NP Location Given:
    7/09/2021 GHC Animal Contact: Mice/Rats C Completed
    Clinician: Farrah Samadi, NP Location Given:
    7/09/2021 GHC TB Individual Baseline Risk Assessment
    L Country
    Clinician: Farrah Samadi, NP Location Given:
    7/09/2021 GHC Smoking N Never
    Clinician: Farrah Samadi, NP Location Given:
    7/09/2021 GHC PrePlacement: Occup Risks C Completed
    Clinician: Farrah Samadi, NP Location Given:
    7/09/2021 GHC Pre-Placement Screening L Cleared
    Clinician: Farrah Samadi, NP Location Given:
    7/09/2021 GHC ADA:Perform Basic Job Duties Y Yes
    Clinician: Farrah Samadi, NP Location Given:
    10/05/2021 GHC Vaccine: Influenza Fluzone Quadrivalent
    C Completed
    0.5 mL
    Drug Company: Glaxo Fluari Lot: LZ4N2 Expiration: 6/30/22 Site: L Deltoi
    Clinician: TEMP TEMP RN/NP Location Given: Clinic
    12/20/2021 GHC Vaccine: COVID Moderna B Booster
    0.5 mL
    Drug Company: Lot: Expiration: Site:
    Clinician: Location Given: External Provider

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