WOODBINE FAMILY HEALTH TEAM

120-135 Queens Plate Drive

Toronto, M9W 6V1
Tel: 416-342-5140
Fax: 416-342-5148

Dec 8, 2020

Adrian Ron Williams

289 Jeffcoat Drive
Etobicoke, ON
M9W 3E4
Phone: 647-960-7591

Dear Adrian:

Immunization record

Yours truly,

Jacqueline Joseph

page 1 of 2
Williams, Adrian Ron Birth date 13/07/2016 #15064 Page 2/2
Dec 8, 2020 Immunizations Yellow Card WB/jj

Immunization Record Date of birth: Jul 13, 2016

Adrian Williams Health Card Number: ON 3565 369 398 HT
Routine Immunizations

Admin Vaccine brand name

Age Date by and lot number
15m 2017-11-08 WB X Varivax III (PF) (lot: M017339)
18m 2018-01-31 CWD X X X X X Pediacel (PF)

CWD Ward, Crystal

WB Bokore, Wasira

Please ask your health care provider about recommendations for the meningococcal, pneumococcal and varicella (chicken pox)
vaccines for specific age groups.
Other Immunizations Tuberculosis TB skin test result
Date Admin Date given Date read Induration size Interpretation
Vaccine
(yyyy-mm-dd) By (yyyy-mm-dd) (yyyy-mm-dd) (mm) (pos/neg)

Contraindications to Immunizations This is your personal immunization record.

Please bring this card to all immunization

appointments: your local public health unit requires
this information when your child goes to school or
daycare.

Dr. Wasira Bokore

Issuing agency

PS Suite® EMR report Printed by jj on Dec 8, 2020 13:54

This document contains personal identifiable information that must be treated confidentially. Any unauthorized use or disclosure is prohibited.