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Immunisation History Statement 3

This immunisation history statement shows that Kirsty C Fordham, born on May 5, 2015, has received all required vaccines according to the National Immunisation Program childhood schedule and is up to date. It lists the specific vaccines, dates administered, and brands from infancy through 4 years of age. The statement notes that immunisations before 1996 are not listed and requests corrections be sent if any information is missing or incorrect.

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Fordham Jess
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320 views2 pages

Immunisation History Statement 3

This immunisation history statement shows that Kirsty C Fordham, born on May 5, 2015, has received all required vaccines according to the National Immunisation Program childhood schedule and is up to date. It lists the specific vaccines, dates administered, and brands from infancy through 4 years of age. The statement notes that immunisations before 1996 are not listed and requests corrections be sent if any information is missing or incorrect.

Uploaded by

Fordham Jess
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Immunisation history statement

As at: 26 November 2020


For: KIRSTY C FORDHAM
Date of birth: 05 May 2015
Immunisation status: up to date

Schedule Date given Immunisation Brand name given

2 months 23 Jun 2015 Diphtheria Tetanus Pertussis Hib Hepatitis B Polio Infanrix Hexa
Pneumococcal Prevenar 13
Rotavirus Rotarix

4 months 01 Sep 2015 Diphtheria Tetanus Pertussis Hib Hepatitis B Polio Infanrix Hexa
Pneumococcal Prevenar 13
Rotavirus Rotarix

6 months 10 Nov 2015 Diphtheria Tetanus Pertussis Hib Hepatitis B Polio Infanrix Hexa
Pneumococcal Prevenar 13

12 months 10 May 2016 Hib Meningococcal C Menitorix


Measles Mumps Rubella Priorix

18 months 31 Oct 2016 Diphtheria Tetanus Pertussis Infanrix


Measles Mumps Rubella Varicella Priorix-Tetra

4 years 20 May 2019 Diphtheria Tetanus Pertussis Polio Quadracel

Other 20 May 2020 Influenza Fluarix Tetra


26 Jun 2020 Influenza Afluria Quad

Next immunisation/s due Date due


No vaccines due.
Notice/s
This individual has received all vaccines required under the National Immunisation Program childhood schedule.

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The Australian Immunisation Register records immunisations given to people of all ages in Australia.
Immunisations given before 1 January 1996 are not displayed on the statement.

Every effort is made to ensure that the information contained on the Australian Immunisation Register is
correct. The data is based on information provided by vaccination providers and the accuracy of data is
dependent on the quality and timeliness of information provided.

If an immunisation is missing from this statement and was given more than one month ago, your
vaccination provider will need to send the missing information to the Australian Immunisation Register. If
any of the immunisation details shown on the statement are not correct, please ask your vaccination
provider to provide the correct details by calling us on 1800 653 809 (call charges may apply).

If you have any questions about this statement, please call the Australian Immunisation Register on the
number above.

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