(19-‫اﻟﺘﻘﺮﻳﺮ اﻟﻄﺒﻲ ﻟﺘﻄﻌﻴﻢ ﻓﺎﻳﺮوس ﻛﻮروﻧﺎ )ﻛﻮﻓﻴﺪ‬

COVID-19 Vaccine Medical Report

Full Name S M MASUD MOHAMMAD ISLAM ‫ﺳ ﻢ ﻣ ﺴ ﻌﻮد ﻣ ﺤ ﻤﺪ ا ﺳﻼم‬ ‫اﻻﺳﻢ‬

ID Number 2235081037 2235081037 ‫ر ﻗ ﻢ ا ﻟ ﻬ ﻮﻳ ﺔ‬

Date of birth 30 Dec 1983 1983 ‫ ​ دﻳﺴﻤﺒﺮ‬30 ‫ﺗﺎرﻳﺦ اﳌﻴﻼد‬

Nationality Bangladesh ‫ﺑ ﻨ ﺠ ﻼ دﻳ ﺶ‬ ‫اﻟ ﺠﻨ ﺴﻴ ﺔ‬

Vaccine Type AstraZeneca (VAXZEVRIA®, COVISHIELD™) ‫أﺳﺘﺮاز ﻳﻨﻴﻜﺎ‬ ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2021-04-01 2021 ‫ ​ أﺑﺮ ﻳﻞ‬01 ‫اﻟﺘﺎرﻳﺦ‬

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

Vaccine Type Pfizer-BionTech (COMIRNATY®) ‫ﺑ ﻴ ﻮﻧ ﺘ ﻚ‬- ‫ﻓ ﺎﻳ ﺰ ر‬ ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2021-07-15 2021 ‫ ​ ﻳﻮﻟﻴﻮ‬15 ‫اﻟﺘﺎرﻳﺦ‬

Batch Number 28115BA 28115BA ‫ر ﻗ ﻢ اﻟﺘ ﺸ ﻐﻴ ﻠ ﺔ‬

Vaccine Type Moderna (SPIKEVAX®) ‫ﻣ ﻮ دﻳ ﺮﻧ ﺎ‬ ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2022-02-23 2022 ‫ ​ ﻓﺒﺮاﻳﺮ‬23 ‫اﻟﺘﺎرﻳﺦ‬

Batch Number 940876 940876 ‫ر ﻗ ﻢ اﻟﺘ ﺸ ﻐﻴ ﻠ ﺔ‬

Vaccine Type Pfizer-BionTech (COMIRNATY®) ‫ﺑ ﻴ ﻮﻧ ﺘ ﻚ‬- ‫ﻓ ﺎﻳ ﺰ ر‬ ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2022-06-29 2022 ‫ ​ ﻳﻮﻧﻴﻮ‬29 ‫اﻟﺘﺎرﻳﺦ‬

Batch Number FN2724 FN2724 ‫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 VCC15072120059 ‫ﻫﺬا اﻟﺘﻘﺮ ﻳﺮ‬

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