Vaccination Record

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Table of contents Birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-5 Medical information related to vaccination. . . . . . . . . . . . . . . . . . . . . . . . . .6-7 Regular vaccination schedule . . . . . . . . . . . . . . . . . .8-9 Diphtheria, tetanus, pertussis (whooping cough), poliomyelitis, Haemophilus influenzae type b infections. . . . . . . . . . . . . . . . . . . . . . . . . . . 10-11 Rotavirus gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . 12 Pneumococcal infection . . . . . . . . . . . . . . . . . . . . . . . 13 Measles, mumps, rubella (German measles), chickenpox (varicella) (Var) . . . . . . . . . . . . . . . . . . . . 14 Meningococcal infection. . . . . . . . . . . . . . . . . . . . . . . 15 Hepatitis B and Human Papillomavirus (HPV) . . . . 16 Hepatitis A and hepatitis B . . . . . . . . . . . . . . . . . . . . . 17 Flu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-21 Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Tuberculine Skin Test (TST) . . . . . . . . . . . . . . . . 22-23 Rabies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-25 Typhoid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Japanese encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . 27 Other vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-30 Immunoglobulins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Yellow fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 2
Birth Place of birth (locality) :_________________________________ Time :_ ___________________ Name of institution :_____________________________________________________________ Length of pregnancy :____________________________________________________________ Type of delivery : vaginal caesarean section Birth weight :___________________ /g Blood group :________ Apgar score :__________________ Cranial circumference :______________ /cm Rh factor :__________________________________________ 3 Length :_ ________________________________________________________________________ /cm
Page 1 and 2: RECORD
Page 3: identification Family name : ______
Page 8: 6 To be completed by the person adm
Page 11 and 12: VACCINES 9 Certain vaccines are rec
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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