Dd Form 2621 - Veterinary Vaccination And Trilingual Health Certificate Page 2

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3. RABIES, DISTEMPER, AND OTHER IMMUNIZATIONS (Continued)/VACCINATION CONTRE LA RAGE, MALADIE DES CHIENS ET AUTRES
IMMUNISATIONS/TOLLWUT, STAUPE, UND ANDERE IMPFUNGEN
TYPE OF VACCINE OR SERUM
VACCINATION TAG NO.
DATE
LOT NO.
AMOUNT
MANUFACTURER
SIGNATURE
TYPE DU VACCIN OR SERUM
NO. DE LA PLAQUE DE
DATE
NO. DU LOT
QUANTITE
FABRICANT
SIGNATURE
ART DER IMPFUNG ODER DES
VACCINATION
DATUM
REG NR.
MENGE
HERSTELLER
UNTERSCHRIFT
SERUMS
IMPFUNGSSCHILD NR.
b.
c.
d.
f.
g.
a.
e.
4.a. REMARKS (Continued)/REMARQUES/VERMERK
DD Form 2621, JUN 92 (Back)
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