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HARVARD UNIT
AMERICAN RED CROSS
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 1939
Date of revaccination since scar Opr17'41 Type of reaction accelerated.
(Required at time of application)
2. Typhoid immunization (within 3 years)
Type
material uned massachusetts Date of expiration of material Nov. '41
Date lst dose mar 27141 Y2CC.
Date 2nd dose Qpri0041 Icc
Date 3rd dose aprel. lc-
3. Diphtheria test and immunization.
Schick test (Required at time of application on all applicants)
Date of test Qpr,3141
Date of reading Apr 7'41
Negative Toxin-e Contro-come
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 Qpr 3'41
Date of reading Qpr.4'41.
Negative Joxin 0.4 x 0.8 cm. control-neg.
Reading:
Positive
Immunization for scarlet fever (Necessary if Dick test is positive)
Type material used
Date of expiration of material
Date of dose
Date apr 21'41
Signed thanles 7. Walest M.D.
8
Date
Signed
M.D.
63479
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"ocrText": "s\nHARVARD UNIT\nAMERICAN RED CROSS\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 1939\nDate of revaccination since scar Opr17'41 Type of reaction accelerated.\n(Required at time of application)\n2. Typhoid immunization (within 3 years)\nType\nmaterial uned massachusetts Date of expiration of material Nov. '41\nDate lst dose mar 27141 Y2CC.\nDate 2nd dose Qpri0041 Icc\nDate 3rd dose aprel. lc-\n3. Diphtheria test and immunization.\nSchick test (Required at time of application on all applicants)\nDate of test Qpr,3141\nDate of reading Apr 7'41\nNegative Toxin-e Contro-come\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 Qpr 3'41\nDate of reading Qpr.4'41.\nNegative Joxin 0.4 x 0.8 cm. control-neg.\nReading:\nPositive\nImmunization for scarlet fever (Necessary if Dick test is positive)\nType material used\nDate of expiration of material\nDate of dose\nDate apr 21'41\nSigned thanles 7. Walest M.D.\n8\nDate\nSigned\nM.D.\n63479"
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