COVID-19 Vaccination Card ID No.

PV-WMETUX

* Please keep this record card, which includes medical information about the vaccines you have received.
* Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong natanggap.

Last Name: First Name: Middle Name: Suffix:

PARBO JADE LAWRENCE REYES
Address 04, RIZAL POBLACION, BANGA, SOUTH COTABATO... Contact No. 09126734802

Date of Birth 09/21/1987 Sex Male Philhealth No. 172010389955 Category A3

Dosage Seq. Date Vaccine Brand Name of Vaccinator Batch No. Lot No.
(mm/dd/yy) (with signature)

1st Dose 07/29/21 JOHNSON & JOHNSON Jeaneth L. Ra, RM 212C21A

2nd Dose N/A N/A N/A

Booster 01/10/22 MODERNA Emillana S. Sumail, RN 086521A

Health Facility Name: RHU SHARIFF AGUAK Contact No: 09355496006

OfficialDOHgov @DOHgoph (632) 8561-7800 Local 1936 covid19.ceir@doh.gov.ph