Please keep this record card, which includes medical information about the vaccines you have received. Por favor, quarde esta tarjeta de registro, que incluye informacion médica sobre las vacunas que ha recibido. COVID- inati diGard' 7 aa Sobeueeercnreenen Ce (ee met Galas pa Last Name First Name Mi mO\ D7.) 2008 ae seer ie Date of Birth Patient number (medical record or IlS record number) ie Product Name/Manufacturer Healthcare Professional Vaccine Date adil or Clinic Site Lot Number “Dose a Ch) a ase oS raat, ame ie Sie OTC "4 Dose ’ 3 2" Dove. Pee —_ FOAL] RA SLbY ay Ra aoe Other mm dd yy ec a alias Other mee yy