Vaccination Worksheet
OMB No. 1405-0230
FORM No. DS-7794
EXPIRATION DATE: 31 Dec 2025
ESTIMATED BURDEN: 60 minutes
Applicant personal details Applicant identity details
Family name: ABUBAKAR Identity document presented: Original Passport
Given names: FNU Identity document number: AT1039611
Sex: MALE Issuing country: PAKISTAN
Date of birth: 11 Jan 2010 Date of issue: 24 Jan 2024
Country of birth: PAKISTAN Date of expiry: 22 Jan 2029
City of birth: SIALKOT Source: Clinic
Prior Country of PAKISTAN
Residence:
Country of Nationality: PAKISTAN
Applicant visa details
Applicant Category Immigrant Visa (excludes diversity)
CEAC Barcode AA00DZ8RBD
Case number ISL2024768034
CEAC Barcode plus suffix AA00DZ8RBD_1
951 Vaccinations
Exam description Applicant's full vaccination history is required.
Exam status Finalized
Reason requested Required under policy
Clinic WilCare Lahore
Exam date 08-Aug-2025
Vaccinations
COVID-19
Pfizer - BioNTech
Vaccine History -
Given by Panel Site
-
-
-
Not Given Insufficient time interval to complete series
Contraindications -
Remarks -
Diphtheria, Tetanus, Pertussis
TT
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ABUBAKAR, FNU
11 Jan 2010
Vaccination Worksheet
Vaccine History -
Given by Panel Site
08 Aug 2025
-
-
Not Given -
Contraindications -
Remarks -
Hepatitis A
Hepatitis A
Vaccine History -
Given by Panel Site
-
-
-
Immunity Positive -
Not Given Not routinely available
Contraindications -
Remarks -
Hepatitis B
Hepatitis B
Vaccine History -
Given by Panel Site
08 Aug 2025
-
-
Immunity Positive -
Not Given -
Contraindications -
Remarks -
Hib
Hib
Vaccine History -
Given by Panel Site
-
-
-
Not Given Not age appropriate
Contraindications -
Remarks -
Influenza
Influenza
Vaccine History -
Given by Panel Site
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ABUBAKAR, FNU
11 Jan 2010
Vaccination Worksheet
-
-
-
Not Given Flu vaccine not available or indicated
Contraindications -
Remarks -
Measles, Mumps, Rubella
MMR
Vaccine History -
Given by Panel Site
08 Aug 2025
-
-
Immunity Positive -
Not Given -
Contraindications -
Remarks -
Meningococcal
MenACWY Conjugate (specify brand in remarks)
Vaccine History -
Given by Panel Site
-
-
-
Not Given Not routinely available
Contraindications -
Remarks -
Pneumococcal
PCV13
Vaccine History -
Given by Panel Site
-
-
-
Not Given Not age appropriate
Contraindications -
Remarks -
Polio
OPV
Vaccine History 23 Jul 2025
Given by Panel Site
-
-
-
Generated: 13 Aug 2025 11:31 AM CEACBC: AA00DZ8RBD Page 3 of 4
ABUBAKAR, FNU
11 Jan 2010
Vaccination Worksheet
Immunity Positive -
Not Given -
Contraindications -
Remarks -
Rotavirus
Rotarix (RV1)
Vaccine History -
Given by Panel Site
-
-
-
Not Given Not age appropriate
Contraindications -
Remarks -
Varicella
Varicella Vaccine
Vaccine History -
Given by Panel Site
08 Aug 2025
-
-
Immunity Positive -
Varicella History No
Not Given -
Contraindications -
Remarks -
Vaccination Documentation
Vaccination requirements complete? Yes
Remarks
-
Attachments
Document Type Attached
- -
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