COVID-19 Vaccine
PrinceEdwardIsland.ca/PEIVaxPass
CANADA Immunization Record Samples
For more information visit: gov.bc.ca/VaccineCard
PAG E 2 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
Paper Record
Electronic Record
Paper Record
Online Record
Wallet-Size CardPaper Record
į Nova Scotia
į Ontario
į Northwest Territories į Nunavut
Paper Record
For more information visit: gov.bc.ca/VaccineCard
PAG E 3 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
COVID-19 VACCINATION RECORDCOVID-19 VACCINATION RECORD
Province of Saskatchewan, CANADAProvince of Saskatchewan, CANADA
Patient
Full Name : FamilyName, GivenName
Date of Birth : 12-May-2000
Age : 21yrs
Date : 27-Aug-2021 09:03 AM
Vaccinations
VaccinationVaccination
DateDateVaccineVaccine LocationLocation SourceSource Lot #Lot #
26-Jun-2021COVID-19 Pfizer-BioNTech mRNA BNT162b2
- COVID-19 mRNARegina - Evraz Hall C (Drive-Thru)
Government of
Saskatchewan3002542
24-Jul-2021COVID-19 Pfizer-BioNTech mRNA BNT162b2
- COVID-19 mRNARegina - Evraz Hall C (Drive-Thru)
Government of
Saskatchewan3003746
PLE ASE N O TE :PLE ASE N O TE :
This document contains COVID-19 immunizations as recorded in the Saskatchewan immunization registry.
It reflects only vaccine information entered into the registry at the time the report was printed, and may not represent all vaccines received by the individual.
PERSONAL HEALTH INFORMATION IS CONFIDENTIAL
Page 1 / 1
Wallet-Size Card
Electronic Record
Paper Record
Electronic Record
Paper Record
į Prince Edward Island
į Quebec
į Saskatchewan
Electronic Record
For more information visit: gov.bc.ca/VaccineCard
PAG E 1 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
IMMUNIZATION RECORD SAMPLESCanada
Paper Record
Paper Record
Paper Record
Online Record
Wallet-Size Card
į Alberta
į Manitoba
į New Brunswick į Newfoundland and Labrador
Electronic Record
For more information visit: gov.bc.ca/VaccineCard
PAG E 1 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
IMMUNIZATION RECORD SAMPLESCanada
Paper Record
Paper Record
Paper Record
Online Record
Wallet-Size Card
į Alberta
į Manitoba
į New Brunswick į Newfoundland and Labrador
Electronic Record
For more information visit: gov.bc.ca/VaccineCard
PAG E 3 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
COVID-19 VACCINATION RECORDCOVID-19 VACCINATION RECORD
Province of Saskatchewan, CANADAProvince of Saskatchewan, CANADA
Patient
Full Name : FamilyName, GivenName
Date of Birth : 12-May-2000
Age : 21yrs
Date : 27-Aug-2021 09:03 AM
Vaccinations
VaccinationVaccination
DateDateVaccineVaccine LocationLocation SourceSource Lot #Lot #
26-Jun-2021COVID-19 Pfizer-BioNTech mRNA BNT162b2
- COVID-19 mRNARegina - Evraz Hall C (Drive-Thru)
Government of
Saskatchewan3002542
24-Jul-2021COVID-19 Pfizer-BioNTech mRNA BNT162b2
- COVID-19 mRNARegina - Evraz Hall C (Drive-Thru)
Government of
Saskatchewan3003746
PLE ASE N O TE :PLE ASE N O TE :
This document contains COVID-19 immunizations as recorded in the Saskatchewan immunization registry.
It reflects only vaccine information entered into the registry at the time the report was printed, and may not represent all vaccines received by the individual.
PERSONAL HEALTH INFORMATION IS CONFIDENTIAL
Page 1 / 1
Wallet-Size Card
Electronic Record
Paper Record
Electronic Record
Paper Record
į Prince Edward Island
į Quebec
į Saskatchewan
Electronic Record
Paper or Electronic Record
Paper Wallet Size Record
SAMPLE
SAMPLE
COVID-19 Vaccine
PrinceEdwardIsland.ca/PEIVaxPass
CANADA Immunization Record Samples
For more information visit: gov.bc.ca/VaccineCard
PAG E 1 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
IMMUNIZATION RECORD SAMPLESCanada
Paper Record
Paper Record
Paper Record
Online Record
Wallet-Size Card
į Alberta
į Manitoba
į New Brunswick į Newfoundland and Labrador
Electronic Record
For more information visit: gov.bc.ca/VaccineCard
PAG E 1 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
IMMUNIZATION RECORD SAMPLESCanada
Paper Record
Paper Record
Paper Record
Online Record
Wallet-Size Card
į Alberta
į Manitoba
į New Brunswick į Newfoundland and Labrador
Electronic Record
Electronic Record
For more information visit: gov.bc.ca/VaccineCard
PAG E 2 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
Paper Record
Electronic Record
Paper Record
Online Record
Wallet-Size CardPaper Record
į Nova Scotia
į Ontario
į Northwest Territories į Nunavut
Paper Record
SAMPLE
COVID-19 Vaccine
PrinceEdwardIsland.ca/PEIVaxPass
CANADA Immunization Record Samples
For more information visit: gov.bc.ca/VaccineCard
PAG E 2 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
Paper Record
Electronic Record
Paper Record
Online Record
Wallet-Size CardPaper Record
į Nova Scotia
į Ontario
į Northwest Territories į Nunavut
Paper Record
For more information visit: gov.bc.ca/VaccineCard
PAG E 3 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
COVID-19 VACCINATION RECORDCOVID-19 VACCINATION RECORD
Province of Saskatchewan, CANADAProvince of Saskatchewan, CANADA
Patient
Full Name : FamilyName, GivenName
Date of Birth : 12-May-2000
Age : 21yrs
Date : 27-Aug-2021 09:03 AM
Vaccinations
VaccinationVaccination
DateDateVaccineVaccine LocationLocation SourceSource Lot #Lot #
26-Jun-2021COVID-19 Pfizer-BioNTech mRNA BNT162b2
- COVID-19 mRNARegina - Evraz Hall C (Drive-Thru)
Government of
Saskatchewan3002542
24-Jul-2021COVID-19 Pfizer-BioNTech mRNA BNT162b2
- COVID-19 mRNARegina - Evraz Hall C (Drive-Thru)
Government of
Saskatchewan3003746
PLE ASE N O TE :PLE ASE N O TE :
This document contains COVID-19 immunizations as recorded in the Saskatchewan immunization registry.
It reflects only vaccine information entered into the registry at the time the report was printed, and may not represent all vaccines received by the individual.
PERSONAL HEALTH INFORMATION IS CONFIDENTIAL
Page 1 / 1
Wallet-Size Card
Electronic Record
Paper Record
Electronic Record
Paper Record
į Prince Edward Island
į Quebec
į Saskatchewan
Electronic Record
COVID-19 Vaccine
PrinceEdwardIsland.ca/PEIVaxPass
CANADA Immunization Record Samples
For more information visit: gov.bc.ca/VaccineCard
PAG E 4 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
COVID-19Proofofvaccination/PreuvedevaccinationcontrelaCOVID-19
Name/Nom:CHARLIE,ZULUDateofbirth/Datedenaissance:05OCT/OCT1999
SMARTHealthCardsQRCodeCodeQRdelacarteSantéSMART
Vaccinationsadministered/Vaccinsreçus:2
Date:25JAN/JAN2021Product/Produit:ModernamRNA-1273Lot:3000489
Date:06MAY/MAI2021Product/Produit:ModernamRNA-1273Lot:3001176
IssuingProvince/TerritoryProvince/Territoirededélivrance
CountryofissuancePaysd’émission
Thisdocumentcontainsconfidentialinformationthatisintendedonlyforusebythenamedindividualorasauthorizedbylaw.Anyunauthorized
disclosure,copying,ordistributionofthecontentsisstrictlyprohibited.Issuedon2021/08/31.Ifthisdocumentisfolded,ensuretheQRcodeisnot
creased.
Cedocumentcontientdesrenseignementsconfidentielsquisontdestinésuniquementàl’usagedelapersonnenomméeouàl’usageautorisépar
laloi.Toutedivulgation,copieoudistributionnonautoriséedesoncontenueststrictementinterdite.Délivréle2021/08/31.Sicedocumentestplié,
assurez-vousquelecodeQRnel’estpas.
Electronic Record
Wallet-Size Card
į Yukon
Temporary Identification Card NDI Canadian Forces Identification Card NDI
į Canadian Department of National Defence
For more information visit: gov.bc.ca/VaccineCard
PAG E 4 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
COVID-19Proofofvaccination/PreuvedevaccinationcontrelaCOVID-19
Name/Nom:CHARLIE,ZULUDateofbirth/Datedenaissance:05OCT/OCT1999
SMARTHealthCardsQRCodeCodeQRdelacarteSantéSMART
Vaccinationsadministered/Vaccinsreçus:2
Date:25JAN/JAN2021Product/Produit:ModernamRNA-1273Lot:3000489
Date:06MAY/MAI2021Product/Produit:ModernamRNA-1273Lot:3001176
IssuingProvince/TerritoryProvince/Territoirededélivrance
CountryofissuancePaysd’émission
Thisdocumentcontainsconfidentialinformationthatisintendedonlyforusebythenamedindividualorasauthorizedbylaw.Anyunauthorized
disclosure,copying,ordistributionofthecontentsisstrictlyprohibited.Issuedon2021/08/31.Ifthisdocumentisfolded,ensuretheQRcodeisnot
creased.
Cedocumentcontientdesrenseignementsconfidentielsquisontdestinésuniquementàl’usagedelapersonnenomméeouàl’usageautorisépar
laloi.Toutedivulgation,copieoudistributionnonautoriséedesoncontenueststrictementinterdite.Délivréle2021/08/31.Sicedocumentestplié,
assurez-vousquelecodeQRnel’estpas.
Electronic Record
Wallet-Size Card
į Yukon
Temporary Identification Card NDI Canadian Forces Identification Card NDI
į Canadian Department of National Defence
For more information visit: gov.bc.ca/VaccineCard
PAG E 3 I M M U N IZ AT I O N R ECO R D SA M PL E S | C A N A DA
COVID-19 VACCINATION RECORDCOVID-19 VACCINATION RECORD
Province of Saskatchewan, CANADAProvince of Saskatchewan, CANADA
Patient
Full Name : FamilyName, GivenName
Date of Birth : 12-May-2000
Age : 21yrs
Date : 27-Aug-2021 09:03 AM
Vaccinations
VaccinationVaccination
DateDateVaccineVaccine LocationLocation SourceSource Lot #Lot #
26-Jun-2021COVID-19 Pfizer-BioNTech mRNA BNT162b2
- COVID-19 mRNARegina - Evraz Hall C (Drive-Thru)
Government of
Saskatchewan3002542
24-Jul-2021COVID-19 Pfizer-BioNTech mRNA BNT162b2
- COVID-19 mRNARegina - Evraz Hall C (Drive-Thru)
Government of
Saskatchewan3003746
PLE ASE N O TE :PLE ASE N O TE :
This document contains COVID-19 immunizations as recorded in the Saskatchewan immunization registry.
It reflects only vaccine information entered into the registry at the time the report was printed, and may not represent all vaccines received by the individual.
PERSONAL HEALTH INFORMATION IS CONFIDENTIAL
Page 1 / 1
Wallet-Size Card
Electronic Record
Paper Record
Electronic Record
Paper Record
į Prince Edward Island
į Quebec
į Saskatchewan
Electronic Record