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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.)
1.2Smallpox vaccination
Date of scar Jan-1935
H
Date of revaccination since scar Dec. I2, I940 Type of reaction immune
a
(Required at time of application)
a
2. Typhoid immunization (within 3 years)
Type
material used typhoid parar-typhoidte of expiration of material Dec. 20, 1941.
vaccine serum P.D.
M
Date lst dose
Dec. 13, I940
Date 2nd dose
Dec. 20, I940
a
4
Date 3rd dose
Dec.27,1940
3. Diphtheria test and immunization.
Schick test (Required at time of application on all applicants)
Date of test
Date of reading
Dec. 13, 1940
Dec. 16 and I8 1940
Negative yes
Reading:
Positive
Diphtheria immunization (Necessary if Schick test is positive)
Type material used
Date of expiration of material
Date lst dose
Date 2nd dose
Date 3rd dose
4. Scarlet fever test and immunization.
Dick test (Required at time of application on all applicants)
Date of test
Dec. 13, I940
Date of reading
Dec. 14, I940
Negative yes
Reading:
Positive
Immunization for scarlet fever (Necessary if Dick test is positive)
Type material used
Date of expiration of material
8
Date of dose
O
Date Dec- 20-1940
Signed Oskostal
M.D.
0
Date
Signed
M.D.
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"ocrText": "B\n?\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.)\n1.2Smallpox vaccination\nDate of scar Jan-1935\nH\nDate of revaccination since scar Dec. I2, I940 Type of reaction immune\na\n(Required at time of application)\na\n2. Typhoid immunization (within 3 years)\nType\nmaterial used typhoid parar-typhoidte of expiration of material Dec. 20, 1941.\nvaccine serum P.D.\nM\nDate lst dose\nDec. 13, I940\nDate 2nd dose\nDec. 20, I940\na\n4\nDate 3rd dose\nDec.27,1940\n3. Diphtheria test and immunization.\nSchick test (Required at time of application on all applicants)\nDate of test\nDate of reading\nDec. 13, 1940\nDec. 16 and I8 1940\nNegative yes\nReading:\nPositive\nDiphtheria immunization (Necessary if Schick test is positive)\nType material used\nDate of expiration of material\nDate lst dose\nDate 2nd dose\nDate 3rd dose\n4. Scarlet fever test and immunization.\nDick test (Required at time of application on all applicants)\nDate of test\nDec. 13, I940\nDate of reading\nDec. 14, I940\nNegative yes\nReading:\nPositive\nImmunization for scarlet fever (Necessary if Dick test is positive)\nType material used\nDate of expiration of material\n8\nDate of dose\nO\nDate Dec- 20-1940\nSigned Oskostal\nM.D.\n0\nDate\nSigned\nM.D."
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