You are on page 1of 1

COVID-19 Vaccination Card Name of

Please keep this record card, which includes medical information about the vaccines you have received.
Dosage Date
Vaccine Brand Vaccinator Batch No. Lot No.
Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong SHM-040642 Seq. (mm/dd/yyyy)
natanggap. (with signature)

1st Dosage / /

2nd Dosage / /

Last Name ENGLIS First Name MARWIN Middle Name A Suffix MENDOZA, PCB0019
1st Booster 9/16/2022 PFIZER
CHRISTIAN C.
-
11/30/2022
Address
BRGY., TAGLATAWAN, CITY OF BAYUGAN, AGUSAN DEL Contact No. 09508392740
SUR
Date of Birth Jan 11, 1996 Sex MALE PhilHealth No. Category A4 2nd Booster / /

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

Fro n t Ba c k

You might also like