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a
AMERICAN RED CROSS
HARVARD UNIT
RECORD OF IMMUNIZATION
(If your own physician does not regularly perform all of these tests, readings, and
immunizations, he will refer you to the proper person in your vicinity.)
1 Smallpox vaccination
Date of scar 1916
Date of revaccination since scar Yom 30 1941
Mrs.
(Required at time of application)
2. Typhoid immunization (within 3 years)
E.
<
Type material used Trifte sphoid (Mors. State)
s
a
Date of expiration of material Oct.10 1941 ,
e
9
Date 1st dose now 27,1940
Date 2nd dose Dec 3,1940
M
P
Date 3rd dose Dec 10, 1940
L.
3. Diphtheria test and immunization.
Schick test (Required at time of application on all applicants)
M
Date of test Des 18,1940 Date of reading Dec 22, 1940
Negative
Reading:
Positive
Diphtheria immunization (Necessary if Schick test is positive.)
Type material used Jovied
Date of expiration of material July 16,1941
Date hst dose Dec 24,1940
Date 2nd dose Dec 31, 1940
,4,' 1971
Date 3rd dose Feb" 1941
4. Scarlet fever test and immunization.
Dick test (Required at time of application on all applicants)
Date of test Dec 17,1940 Date oI reading Dec 18, 1941)
Negative
Reading:
Positivo
Immunization for scarlet f'ever (Necessary ir Dick test is positive)
Date of dose Nonecessary
Date Febr 6, 1941.
signed perance
M.D.
Date
Signed
M.D.
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Context sent to Scholar
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"ocrText": "Z\nI\ne\ne\nn\na\nAMERICAN RED CROSS\nHARVARD UNIT\nRECORD OF IMMUNIZATION\n(If your own physician does not regularly perform all of these tests, readings, and\nimmunizations, he will refer you to the proper person in your vicinity.)\n1 Smallpox vaccination\nDate of scar 1916\nDate of revaccination since scar Yom 30 1941\nMrs.\n(Required at time of application)\n2. Typhoid immunization (within 3 years)\nE.\n<\nType material used Trifte sphoid (Mors. State)\ns\na\nDate of expiration of material Oct.10 1941 ,\ne\n9\nDate 1st dose now 27,1940\nDate 2nd dose Dec 3,1940\nM\nP\nDate 3rd dose Dec 10, 1940\nL.\n3. Diphtheria test and immunization.\nSchick test (Required at time of application on all applicants)\nM\nDate of test Des 18,1940 Date of reading Dec 22, 1940\nNegative\nReading:\nPositive\nDiphtheria immunization (Necessary if Schick test is positive.)\nType material used Jovied\nDate of expiration of material July 16,1941\nDate hst dose Dec 24,1940\nDate 2nd dose Dec 31, 1940\n,4,' 1971\nDate 3rd dose Feb\" 1941\n4. Scarlet fever test and immunization.\nDick test (Required at time of application on all applicants)\nDate of test Dec 17,1940 Date oI reading Dec 18, 1941)\nNegative\nReading:\nPositivo\nImmunization for scarlet f'ever (Necessary ir Dick test is positive)\nDate of dose Nonecessary\nDate Febr 6, 1941.\nsigned perance\nM.D.\nDate\nSigned\nM.D."
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