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Immunization Record Excel Template

Immunization Record




Date of Birth

Medical Notes

Vaccine Date Administered by Location Next Dosage Reaction Notes
Hepatitis B          
Diphtheria, Tetanus, Pertussis          
H. Influenza type b          
Inactivated Poliovirus          
Measles, Mumps, Rubella          
Varicella (Chickenpox)          
Hepatitis A          
Human Papillomavirus          
Influenza (yearly vaccine)          
Other Vaccines          

Notes on Immunization Record Example

Use this Immunization Record to keep track of yours or your child's immunizations.

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Download Example Immunization Record Excel Template