Vaccination Record

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VACCINES Certain vaccines are recommended for everyone. They are part of the regular vaccination schedule. Regular vaccination schedule (as of November 1, 2011) Between 2 and 23 months At 2, 4, 6 and 18 months At 12 months At 18 months DTaP-Polio-Hib PROTECTION AGAINST : • diphtheria (D) • tetanus (T) • pertussis (whooping cough) (aP) • poliomyelitis (Polio) • severe Haemophilus influenzae type b infections (Hib) At 2 and 4 months PNEUMOCOCCAL CONJUGATE PROTECTION AGAINST : • serious infections caused by the pneumococcal germ rotavirus PROTECTION AGAINST : • Rotavirus gastroenteritis PNEUMOCOCCAL CONJUGATE PROTECTION AGAINST : • serious infections caused by the pneumococcal germ mEningocoCCUS PROTECTION AGAINST : • group C meningococcal infection mMR-Var PROTECTION AGAINST : • measles (M) • mumps (M) • rubella (German measles) (R) • chickenpox (Var) mMR PROTECTION AGAINST : • measles (M) • mumps (M) • rubella (German measles) (R) Between 6 and 23 months FLU During the flu season PROTECTION AGAINST : • Flu 8
VACCINES 9 Certain vaccines are recommended for everyone. They are part of the regular vaccination schedule. Regular vaccination schedule (as of November 1, 2011) Between 4 and 16 years of age Between 4 and 6 years of age En 4 th year of elementary school Between 14 and 16 years of age Tdap-Polio Hepatitis B Tdap* PROTECTION AGAINST : PROTECTION AGAINST : PROTECTION AGAINST : • tetanus (T) • hepatitis B • tetanus (T) • diphtheria (d) including a protection against hepatitis A • pertussis (whooping • diphtheria (d) • pertussis (ap) cough) (ap) HPV (girls) • poliomyelitis (Polio) PROTECTION AGAINST : • HPV The annual flu vaccination for those aged 60 or older, and the pneumococcal polysaccharide vaccination at age 65, are also part of the regular vaccination schedule. Other vaccinations may be recommended for reasons of health, work, activities or travel. Subsequently, a booster of Td vaccine every 10 years thereafter. * A dose of this vaccine is also indicated for all adults. HPV (girls) PROTECTION AGAINST : • HPV
Page 1 and 2: RECORD
Page 3 and 4: identification Family name : ______
Page 5 and 6: Birth Place of birth (locality) :__
Page 8: 6 To be completed by the person adm
Page 14 and 15: 12 Rotavirus gastroenteritis Date (
Page 16 and 17: Measles (M) - Mumps (M) - Rubella (
Page 18 and 19: Hepatitis B Human Papillomavirus (H
Page 20: Flu Date (year-month-day) Name of v
Page 24 and 25: Tuberculosis Date (year-month-day)
Page 26: Rabies Date (year-month-day) Name o
Page 29 and 30: Japanese encephalitis Date (year-mo
Page 31 and 32: Vaccine against : Vaccine against :
Page 33 and 34: Immunoglobulins Date (year-month-da
Page 35 and 36: Place international certificate of

Vaccination Record

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