COVID-19 Vaccination Record Card
Pleasé keep this record card, which jncludes medical information
about the vaccines you have received.
Por favor, guarde esta tarjeta de registro, que incluye información
médica sobre las vacunas que ha recibido.*ry
Last Name
Date of birth
Vaccine
1'r Dose
covtD-r 9
2"d Dose
covtD-19
Other
OtherFirst Name I\41
Patient number lmedical record or llS record numbel
Healthcare Professional
or Clini< Site
C¡rlos E ]lernandez
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Nerl Appoírt?neDt: ::?,r;i llorilpletedProduct Name/Manufacturer
Lot NumberDate
Reminder! Return for a second dose!
¡Recordatorio!¡ Regresepara la segunda dosis!
VaccineDate / Fe(ha
COVID-1 9 vaccine
Vacuna contra el COVID-1 9/tmmddW
Other
Otra
Bring this vaccination record to every!acc.nation or medic¿l visit. Cl-,ecl wirh ¡ or.lealth c¿re p.ovioer lo aake sure you a,e notmissing any doses of routinely recommended
vacclneS.LJeve este reg
cita médica oistro de
de
su proveedor de
asegurarse de
de las vacunasq
l,t
IFor more ¡nformation about COVID-19
and (OVID-19 vaccine, visit cdc.gov/(oronavirus/20 1 9-ncov/index.h-tml.
vou can report possrole adverse reactionslorlowing COVID-19 vacc¡nation to the
V¿cch_e Adveree tvent Repo.ting Sy)tem
(VAERS) at vaers.hhs.gov.
rt./¡l/,209,
19-
Puede not¡tc¿l las pos,bles reaLcioles
adversas despues de l¿ vacun¿c on colTrd
el COVID 19 ¿l Sislema oe \ot qcac,or deHeacciones Adversas a l¿! V¿crras VA IRS/en vaers.hhs.gov.
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