CHILD IMMUNIZATION RECORD

SAMANTHA
CHILD’S NAME: ____________________ MYRNA
MOTHER’S NAME: ____________________
JULY 05, 2014
DATE OF BIRTH: ___________________ JOSEPH
FATHER’S NAME: ____________________
CEBU CITY
PLACE OF BIRTH: __________________ 3.18 kg HEIGHT: __________
WEIGHT: __________ 52 cm

37.3
TEMP.___________ 130 bpm
PULSE: __________ 45 cpm
RR: __________ FEMALE
SEX: ______________

VACCINE DOSES DATE OF IMMUNIZATION REMARKS

BCG 1 COMPLETED
07/05/14
(at birth)
HEPATITIS B 1 COMPLETED
07/05/14
(at birth)
PENTAVALENT 3 COMPLETED
VACCINE(DPT,HEP.B,HIB) 08/16/14 09/13/14 10/11/14
(1 ½,21/2,3 ½ months)
3 COMPLETED
08/16/14 09/13/14 10/11/14
ORAL POLIO VACCINE (OPV) (1 ½,21/2,3 ½ months)
1 COMPLETED
10/11/14
INACTIVATED POLIO VACCINE (IPV) 3 ½ months
PNEUMOCOCCAL CONJUGATE 3 COMPLETED
VACCINE (PCV) 08/16/14 09/13/14 10/11/14
(1 ½,21/2,3 ½ months)
MEASLES, MUMPS,RUBELLA(MMR) 2 COMPLETED
04/05/15 07/05/15
(9months & 1 year)

CHILD IMMUNIZATION RECORD

NICOLE MARITES
 CHILD’S NAME: ____________________ MOTHER’S NAME: ____________________

DATE OF BIRTH: ___________________ APRIL 11, 2011

FATHER’S NAME: ____________________ WINNIE

PLACE OF BIRTH: __________________ CEBU CITY

WEIGHT: 3.6 kg
__________ HEIGHT: __________ 53 cm

TEMP.___________ 37.3
PULSE: __________ 135 bpm
RR: __________ 42 cpm
SEX: ______________ FEMALE

VACCINE DOSES DATE OF IMMUNIZATION REMARKS

BCG 1
04/11/11
(at birth)
HEPATITIS B 1
04/11/11
(at birth)
PENTAVALENT 3
VACCINE(DPT,HEP.B,HIB) 05/23/11 06/20/11 07/18/11
(1 ½,21/2,3 ½ months)
3
05/23/11 06/20/11 07/18/11
ORAL POLIO VACCINE (OPV) (1 ½,21/2,3 ½ months)
1
07/18/11
INACTIVATED POLIO VACCINE (IPV) 3 ½ months
PNEUMOCOCCAL CONJUGATE 3
VACCINE (PCV) 05/23/11 06/20/11 07/18/11
(1 ½,21/2,3 ½ months)
MEASLES, MUMPS,RUBELLA(MMR) 2
01/11/12 04/11/12
(9months & 1 year)