(19-‫اﻟﺘﻘﺮﻳﺮ اﻟﻄﺒﻲ ﻟﺘﻄﻌﻴﻢ ﻓﺎﻳﺮوس ﻛﻮروﻧﺎ )ﻛﻮﻓﻴﺪ‬

COVID-19 Vaccine Medical Report

Full Name MOHAMMAD ALI - IMAM ‫ ا ﻣﺎ م‬- ‫ﻣ ﺤ ﻤ ﺪ ﻋ ﲇ‬ ‫اﻻﺳﻢ‬

ID Number 2449734074 2449734074 ‫ر ﻗ ﻢ ا ﻟ ﻬ ﻮﻳ ﺔ‬

Date of birth 27 Jan 1993 1993 ‫ ​ ﻳﻨﺎﻳﺮ‬27 ‫ﺗﺎرﻳﺦ اﳌﻴﻼد‬

Nationality India ‫اﻟ ﻬﻨ ﺪ‬ ‫اﻟ ﺠﻨ ﺴﻴ ﺔ‬

Vaccine Type ‫أﺳﺘﺮاز ﻳﻨﻴﻜﺎ‬-‫أﻛﺴﻔﻮرد‬ Oxford-AstraZeneca ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2021-04-07 2021 ‫ ​ أﺑﺮ ﻳﻞ‬07 ‫اﻟﺘﺎرﻳﺦ‬

Batch Number 4121Z027 4121Z027 ‫ر ﻗ ﻢ اﻟﺘ ﺸ ﻐﻴ ﻠ ﺔ‬

Vaccine Type ‫أﺳﺘﺮاز ﻳﻨﻴﻜﺎ‬-‫أﻛﺴﻔﻮرد‬ Oxford-AstraZeneca ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2021-07-25 2021 ‫ ​ ﻳﻮﻟﻴﻮ‬25 ‫اﻟﺘﺎرﻳﺦ‬

Batch Number NJ0133 NJ0133 ‫ر ﻗ ﻢ اﻟﺘ ﺸ ﻐﻴ ﻠ ﺔ‬

‫ اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬،‫ﺗﻢ إﺻﺪار ﻫﺬا اﻟﺘﻘﺮ ﻳﺮ ﻣﻦ ﻗﺒﻞ وزارة اﻟﺼﺤﺔ‬

‫ﻫﺬا اﻟﺘﻘﺮ ﻳﺮ ﻟﻺﺳﺘﺨﺪام اﻟﻄﺒﻲ ﺧﺎرج اﳌﻤﻠﻜﺔ ﰲ اﻟﺪول اﻟﱵ ﻟﻢ ﺗﺮﺗﺒﻂ إﻟﻜﺘﺮوﻧﻴﺎ ﻣﻊ اﻷﻧﻈﻤﺔ اﻟﺤﻜﻮﻣﻴﺔ ﰲ اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬

This Report has been issued by the Ministry of Health, Kingdom of Saudi Arabia

This report is intended to be used for medical purposes outside the Kingdom of Saudi Arabia, in the countries that are not integrated with
the Kingdom's government systems.

Kindly scan the QR code to vaildate Report No. ‫رﻗﻢ اﻟﺘﻘﺮ ﻳﺮ‬ ‫ﻳﺮﺟﻰ ﻣﺴﺢ اﻟﺒﺎرﻛﻮد ﻟﻠﺘﺤﻘﻖ ﻣﻦ ﺻﺤﺔ‬

this report VCC070421204726 ‫ﻫﺬا اﻟﺘﻘﺮ ﻳﺮ‬

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