; / 
rM 
t 
IMMUNIZATION REGISTER 1 
ARMY SERIAL NO. 
LAST NAME FIRST NAME 
,4&/£T~S*ioA^ 
SMALLPOX VACCINE 
" DATE 
TYPE OF REACTION 6 
MED. OFFICER 3 
- 
m 
TRIPLE TYPHOID VACCINE 
DATES OF ADMINISTRATION 
MED. OFFICER 2 
SERIES 
1ST DOSE 
2D DOSE 
3D DOSE 
1 st 
• 
2d_ 
J 
3d_ 
TETANUS TOXOID 
INITIAL VACCINATION 
STIMULATING DOSES 
DATE 
MED. OFF. 2 
4 SV 
DATE 
MED. OFF. 3 
1st dose_ 
2d dose _ 
V ]/* 
j/ r 
J 
2l£1 
--- - 
W-l&A; 
Jtoi 
3d dose__ 
m 9 VJF J 
. . n ■ 
j 
YELLOW FEVER VACCINE 
DATE 
LOT NO. 
AMOUNT 
* 
MED. OFF. 2 
• 
• • 
* 
OTHER VACCINES 
DISEASE 
DATE 
TYPE OF 
VACCINE 
DOSES 
MED. OFF. 3 
•A »* 
, r 
- if*-—-» C., 
* S. Army. 
16—2 
!i 
