EFTA00059482


Bureau of Prisons
Health Services
Immunizations

<table><thead><tr><th>Immunization</th><th>Immunization Date</th><th>Administered</th><th>Location</th><th>Dosage Drug Mfg.</th><th>Lot #</th><th>Exp Date</th></tr></thead><tbody><tr><td>Hepatitis A and B (TwinRx)</td><td></td><td>History Unknown</td><td></td><td></td><td></td><td></td></tr><tr><td>Orig Entered: 07/09/2019 12:51 EST</td><td></td><td>.MLP</td><td></td><td></td><td></td><td></td></tr><tr><td>Measles/Mumps/Rubella Series</td><td></td><td>History Unknown</td><td></td><td></td><td></td><td></td></tr><tr><td>Orig Entered: 07/09/2019 12:51 EST</td><td></td><td>.MLP</td><td></td><td></td><td></td><td></td></tr><tr><td>Smallpox Series</td><td></td><td>History Unknown</td><td></td><td></td><td></td><td></td></tr><tr><td>Orig Entered: 07/09/2019 12:51 EST</td><td></td><td>.MLP</td><td></td><td></td><td></td><td></td></tr><tr><td>Tetanus</td><td></td><td>History Unknown</td><td></td><td></td><td></td><td></td></tr><tr><td>Orig Entered: 07/09/2019 12:51 EST</td><td></td><td>.MLP</td><td></td><td></td><td></td><td></td></tr><tr><td>Varicella Series</td><td></td><td>History Unknown</td><td></td><td></td><td></td><td></td></tr><tr><td>Orig Entered: 07/09/2019 12:51 EST</td><td></td><td>.MLP</td><td></td><td></td><td></td><td></td></tr><tr><td>Total: 5</td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>

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RN/IOP/IDC

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Bureau of Prisons - NYM