Vaccination Record - Confidential Information

Healthy Happy Children Medical Services, 1300 Main Ave, Ste 2C, Clifton, NJ
Return Address: 973-340-6666
Ariolis Grullon, MD
1300 Main Avenue, Suite 2C Date printed: 10/12/2022
Clifton, NJ 070112266
Your Next Appointment:

THOM KHATER
334 HOLLYWOOD AVE
Fairfield, NJ 07004
Patient: 342 : AMIR KHATER SEX: M D.O.B.: 10/12/2014
Age on date printed: 8 yrs. 0 mos.
Message..... It is important that your child's immunization record is up to date and accurate. Please
notify us of any corrections or updates immediately. Thank you.
Vaccination Forecast: ......... Recommended Range...... Earliest
..........................................................................................
..........
Flu - Seasonal ..... Today -
COVID19 ............ Today -
-
Allergies... No active medication allergies or reactions; No documented food/non-medication allergies

IMMUNIZATIONS
Hep B HIB D-T-P Group Polio
HepB 10/13/2014 DTaP-HIB-IPV 12/30/2014 DTaP-HIB-IPV 12/30/2014 DTaP-HIB-IPV 12/30/2014
HepB 12/30/2014 DTaP-HIB-IPV 02/18/2015 DTaP-HIB-IPV 02/18/2015 DTaP-HIB-IPV 02/18/2015
HepB 05/04/2015 DTaP-HIB-IPV 05/04/2015 DTaP-HIB-IPV 05/04/2015 DTaP-HIB-IPV 05/04/2015
HIB-PRP-T 01/13/2016 DTaP 01/13/2016 DTaP-IPV 11/14/2018
DTaP-IPV 11/14/2018
Pneumococcal Rotavirus MMR Varicella
PCV13 12/30/2014 RotaVirus 12/30/2014 MMR 11/11/2015 VAR 11/11/2015
PCV13 02/18/2015 RotaVirus 02/18/2015 MMRV 11/14/2018 MMRV 11/14/2018
PCV13 05/04/2015 RotaVirus 05/04/2015
PCV13 03/21/2016 Influenza
Meningococcal ACWY
FLU-IIV3 6-35m pf 11/11/2015
Hep A Other Vaccines FLU-IIV3 6-35m pf 03/21/2016
HepA 2dose 03/21/2016 FLU-IIV3 6-35m pf 12/02/2016
HepA 2dose 09/21/2016 FLU-IIV4 6m+ pf 12/03/2018
MenB
Covid19
Td Group

MenCY
HPV

*Only 4 most recent Flu listed

10/12/2022 03:39 PM Ariolis Grullon, MD

Copyright Office Practicum New Jersey 25MA0918110