Editing 2532: Censored Vaccine Card
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Latest revision | Your text | ||
Line 65: | Line 65: | ||
:Date of birth Patient number | :Date of birth Patient number | ||
− | : | + | :{| class="wikitable" |
− | + | | Vaccine | |
− | + | | Manufacturer lot number | |
− | + | | Date | |
− | + | | Provider or clinic site | |
− | + | |- | |
− | + | | 1st Dose<br/>COVID-[censored] | |
+ | | '''Pfizer ER1138''' | ||
+ | | '''04'''/'''01'''/'''21'''<br/>MM DD YY | ||
+ | | '''CVS Pharmacy Clinician #5309''' | ||
+ | |- | ||
+ | | 2nd Dose<br/>COVID-[censored] | ||
+ | | '''Pfizer ES2187''' | ||
+ | | '''04'''/'''22'''/'''21'''<br/>MM DD YY | ||
+ | | '''CVS''' [censored] [censored] | ||
+ | |- | ||
+ | | Other | ||
+ | | <sup>'''3rd dose'''</sup> [censored] '''FH1729''' | ||
+ | | '''10'''/'''21'''/'''21'''<br/>MM DD YY | ||
+ | | [censored] [censored] [censored]'''CIA'''[censored] | ||
+ | |- | ||
+ | | Other | ||
+ | | [censored] | ||
+ | | [censored]/[censored]/[censored]<br/>MM DD YY | ||
+ | | [censored] | ||
+ | |} | ||
:[Caption below panel:] | :[Caption below panel:] |