HomeMy WebLinkAboutImmunization register for Francis and Richard Badgett IMMUNIZATION REGISTER' IMMUNIZATION REGISTER'
LAST NAME FIRST NAME ARMY SERIAL NO. LAST NAME FIRST NAME ARMY SERIAL NO.
Badgett, Frances t1. Badgett, Richard H.
GRADE COMPANY REGT.OR STAFF CORPS AGE RACE GRADE COMPANY 1REGT. OR STAFF CORPS AGE R
1 ACE
SMALLPDX VACCINE SMALLPDX VACCINE
DATE TYPE OF REACTION MED. OFFICER DATE TYPE OF REACTION MED. OFF R
- .-,. - - 1 '' -
TRIPLE TYPHOID VACCINE TRIPLE TYPHOID VACCINE
DATES OF ADMINISTRATION DATES OF ADMINISTRATION
MED. OFFICER MED. OFFICER
SERIES 1ST DOSE i 2D DOSE 3D DOSE SERIES 1ST DOSE 2D DOSE , . DOSE
1st -43 , 1st___37 6 -43 .25 cc .I
2d___.21,. -43- - - - , I 2 d---- 3 r - - 43 .5 cc _ �
3d- -4- 6 -4 3d 4— —43 .5 cc 4
TETANUS TOXOID TETANUS TOXOID
INITIAL VACCINATION STIMULATING DOSES INITIAL VACCINATION STIMULATING DOSES
DATE MED. OFF. DATE MED. OFF. DATE MED. OFF. - DATE MED. OFF.
1st dose_ 1st dose_
2d dose_ 2d dose_
3d dose_ 3d dose_
YELLOW FEVER VACCINE YELLOW FEVER VACCINE
DATE LOT No. AMOUNT MED. OFF. DATE LOT No. AMOUNT MED. OFF.
OTHER VACCINES OTHER VACCINES
TYPE OF DATE MFR'S. LOT AMOUNT MED. OFF., TYPE OF DATE MFR'S. LOT AMOUNT MED. OFF.
VACCINE N0. VACCINE N0.
Or ' / / Olf
t , M. C., , M. C., •
16 -2E -I E . KOTTKE, Capt. U.S. m Army.
� , ] €-2�.;t W. PIERCE, Is #• At;tl• Pa. (
I .
INSTRUCTIONS INSTRUCTIONS
1. A record will be kept on this form of all vaccina- 1. A record will be kept on this form of all vaccina-
tions given under the direction of medical officers to tions given under the direction of medical officers to
military and civilian personnel. See AR 40-210 for military and civilian personnel. See AR 40-210 for
further details. further details.
2. Appropriate entries will be made at the time 2. Appropriate entries will be made at the time
prophylactic vaccinations are made and the entries prophylactic vaccinations are made and the entries
will be authenticated by the written initials of the will be authenticated by the written initials of the
medical officer making the inoculation. medical officer making the inoculation.
3. In the case of a civilian employee, the character 3. In the case of a civilian employee, the character
of his employment (clerk, teamster, etc.) and the of his employment (clerk, teamster, etc.) and the
staff corps or department in which he is employed will staff corps or department in which he is employed will
be noted in the space Regiment or Staff Corps. A be noted in the space Regiment or Staff Corps. A
brief notation of the status of other civilians will be brief notation of the status of other civilians will be
made in the same space. made in the same space.
4. All officers, warrant officers, nurses, civilians, 4. All officers, warrant officers, nurses, civilians,
and others furnished authenticated vaccination reg- and others furnished authenticated vaccination reg-
isters will preserve them for reference purposes to isters will preserve them for reference purposes to
be exhibited to examining medical officers at home be exhibited to examining medical officers at home
and to foreign health and quarantine officers upon and to foreign health and quarantine officers upon
transfer to overseas duty. See AR 615 -250. transfer to overseas duty. See AR 615 -250.
5. The duplicate copy of the immunization register 5. The duplicate copy of the immunization register
will be held for at least 2 years in an alphabetical im- will be held for at least 2 years in an alphabetical im-
munization file maintained with the Medical Depart- munization file maintained with the Medical Depart-
ment records of the station at which the record was ment records of the station at which the record was
prepared. See AR 40 -1005. prepared. See AR 40 -1005.
6. Record as vaccina, vaccinoid, or immune reac- 6. Record as vaccina, vaccinoid, or immune mac-
tion. ' If there is no reaction, or if the reaction fails tion. If there is no reaction, or if the reaction fails
to conform to any of the three recognized types, to conform to any of the three recognized types,
vaccination will be repeated. The use of the term vaccination will be repeated. The use of the term
"unsuccessful vaccination" on official records will not "unsuccessful vaccination" on official records will not
be used. be used.
Form 81 Form S1
MEDICAL DEPARTMENT, U. S. A. MEDICAL DEPARTMENT, U. S. A.
(Revised Sept. 23, 1942) (Revised Sept. 23, 1942)
16-20202-1 16- 20202 -1