Live chart source: Elation · read-only in Northstar; make clinical chart changes in Elation
Theodore Petersen
8y, MDOB 2018-08-28 · ID ba34bcf4
No active allergy records returned. Confirm allergy status with the patient or caregiver.
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Immunization record
Theodore Petersen · DOB 2018-08-28 · printed 9/7/2026
Northstar pediatric record. For school, camp, and childcare submission.
| Vaccine | Date | Lot | Manufacturer |
|---|---|---|---|
| HepB-Peds | 2018-09-05 | LR2T7 | GlaxoSmithKline |
| Rotavirus, pentavalent 3-dose | 2018-11-06 | R002805 | Merck and Co., Inc. |
| Pneumo-PCV13 | 2018-11-06 | W28770 | Pfizer, Inc. |
| Hib-OMP | 2018-11-06 | R013572 | Merck and Co., Inc. |
| DTAP/Polio/Hep B | 2018-11-06 | 4ZH95 | GlaxoSmithKline |
| Rotavirus, pentavalent 3-dose | 2019-01-07 | R021648 | Merck and Co., Inc. |
| Pneumo-PCV13 | 2019-01-07 | X35262 | Pfizer, Inc. |
| Hib-OMP | 2019-01-07 | R021076 | Merck and Co., Inc. |
| DTAP/Polio/Hep B | 2019-01-07 | KZ4TM | GlaxoSmithKline |
| Rotavirus, pentavalent 3-dose | 2019-03-12 | R017948 | Merck and Co., Inc. |
| Fluarix quad pfree | 2019-03-12 | 49Z43 | GlaxoSmithKline |
| Pneumo-PCV13 | 2019-03-12 | X49142 | Pfizer, Inc. |
| DTAP/Polio/Hep B | 2019-03-12 | 2HC47 | GlaxoSmithKline |
| Fluarix quad pfree | 2019-09-10 | 7AR35 | GlaxoSmithKline |
| Varicella | 2019-09-10 | S008695 | Merck and Co., Inc. |
| MMR | 2019-09-10 | R036580 | Merck and Co., Inc. |
| HepA-Ped 2 Dose | 2019-09-10 | BE554 | GlaxoSmithKline |
| Pneumo-PCV13 | 2019-12-10 | X39679 | Pfizer, Inc. |
| Hib-OMP | 2019-12-10 | S007078 | Merck and Co., Inc. |
| DtaP | 2019-12-10 | NG5GF | GlaxoSmithKline |
| Fluarix quad pfree | 2020-02-17 | E5C24 | GlaxoSmithKline |
| Fluarix quad pfree | 2020-09-19 | AJ3AC | GlaxoSmithKline |
| HepA-Ped 2 Dose | 2020-09-19 | N592C | GlaxoSmithKline |
| Flu, quadrivalent, pfree | 2021-09-10 | 3SE27 | GlaxoSmithKline |
| Spikevax-MOD 25mcg PEDS | 2022-06-26 | AS1416B | — |
| Spikevax-MOD 25mcg PEDS | 2022-07-25 | AR9237B | Moderna US, Inc. |
| Fluarix quad pfree | 2022-09-07 | 9337Z | GlaxoSmithKline |
| MMRV | 2022-09-07 | W017567 | Merck and Co., Inc. |
| Kinrix | 2022-09-07 | G9N2M | GlaxoSmithKline |
| Flucelvax quad pfree | 2023-10-14 | 944493 | Seqirus |
| Flu, trivalent, MDCK, pfree | 2024-10-10 | 946581 | Seqirus |
| Spikevax 6m-11y Intramuscular Suspension Prefilled Syringe 25 MCG/0.25ML (covid-19) | 2025-10-11 | 30523667 | Moderna US, Inc. |
| Fluzone Intramuscular Suspension Prefilled Syringe 0.5 ML (TIV, inactivated) | 2025-10-11 | U8889CA | SANOFI |