Vaccination Status Record

Immunizations/Vaccinations Required Recommended Date
Completed
Cholera
Diphtheria, Tetanus, Pertussis
(Tdap)
Diphtheria-tetanus
Hepatitis A
Hepatitis B
Hepatitis A/B Combination
H. influenzae type b
Human papillomavirus
Influenza
Japanese encephalitis
Measles, Mumps, Rubella
Meningococcal meningitis
Pneumococcal (Prevnar or Pneumovax)
Poliomyelitis, primary series
Polio booster
Rabies
Rotavirus
Tetanus, Diphtheria (Td)
Tetanus, Diphtheria, Pertussis (Tdap)
Typhoid
Varicella (chicken pox)
Shingles (herpes zoster)
Yellow fever
Other: