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2023 07 11 12-08-57 PM

This document provides general instructions for a COVID-19 vaccination card. It instructs the recipient to bring the card for each vaccine dose, inform staff of any issues after vaccination, and check for appointment details via SMS. It also lists how to download a replacement card if lost and get a vaccination certificate online. The recipient's personal details and vaccination history for 4 doses are recorded on the card, including vaccine type, date administered, and vaccinator signature. [The recipient also provides consent for vaccination and future reporting/research, acknowledging potential side effects.]

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lokman hossen
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499 views1 page

2023 07 11 12-08-57 PM

This document provides general instructions for a COVID-19 vaccination card. It instructs the recipient to bring the card for each vaccine dose, inform staff of any issues after vaccination, and check for appointment details via SMS. It also lists how to download a replacement card if lost and get a vaccination certificate online. The recipient's personal details and vaccination history for 4 doses are recorded on the card, including vaccine type, date administered, and vaccinator signature. [The recipient also provides consent for vaccination and future reporting/research, acknowledging potential side effects.]

Uploaded by

lokman hossen
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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General instructions

Covid-19 Vaccination Card


> Bring this Vaccine Card to the designated immunization center on the due date
Registration No- 302649246543133747 Date- 11/09/2021
of 1st, 2nd and 3rd dose of Covid-19 vaccine.
Name- MOHAMMAD LOKMAN HOSSEN
> Inform the immunization worker immediately if there is any problem / difficulty
Date of Birth- 19/11/1992 Age- 30 after vaccination. If necessary, bring the intended people to the nearest health
Passport No- center.
Country- Bangladesh
BO0020664
House No.- F/3 Boshir Uddin > Before vaccination, the vaccination center and the date of vaccination will be
Town/Area- F/3 Boshir Uddin Road informed via SMS.
Road
Upazila/City Corporation- Dhaka South City Corporat Ward No.- 17
> Keep the card for future use even if the vaccination is completed
District- Dhaka Union- Dhanmondi
Center Name- Maternal and Child Health Training Institute
>If the vaccine card is lost, it can be downloaded from the website
Vaccinator Information www.surokkha.gov.bd.
Name- - > Certificate can be collected from www.surokkha.gov.bd after completion of 2
doses of Covid-19 vaccine.
Center ID- 264920958
Mobile- -
Covid-19 Vaccination Information > Even if you get vaccinated against Covid-19, follow proper health rules.
Date of Receiving the Date of Vaccination &
Vaccine Dose
Vaccine Vaccinator Signature

1st Dose 28/09/2021 28/09/2021

2nd Dose 30/10/2021 30/10/2021 With your cooperation, the Government of Bangladesh is committed to deliver the Covid-19
vaccine to all who are targeted.

3rd Dose 23/03/2022 22/05/2022 Expanded Programme on Immunization (EPI)


Directorate General of Health Services
Ministry of health and family welfare
4th Dose 18/02/2023
:: In collaboration with ::

Dose-1: Moderna (Moderna)

Dose-2: Moderna (Moderna)


Vaccine Name,
Manufacturer,
Batch Number
Dose-3: AstraZeneca (AstraZeneca)

Dose-4: N/A

----------------------------------------------------------------------------------------------------

Vaccine Recipient's Consent Paper

Registration No- 302649246543133747 Registration Date- 11/09/2021 Passport No- BO0020664


Name- MOHAMMAD LOKMAN HOSSEN
Country- Bangladesh

> Information about the Covid-19 vaccine has been explained to me online and face-to-face.
> I do agree to provide information about vaccination and its effects when required.
> In my knowledge, I don't have any drug allergies.
> I hereby providing my consent for the preparation of post-vaccination report / research paper.
> I hereby voluntarily agree to get vaccinated, knowing the benefits and side effects of this vaccine (swelling at the site of vaccination, mild fever, headache,
nausea, headache and body aches).

Signature of the Vaccine recipients ------------------------------------------------------ Date- ------------------------------------------------------

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