Survey Text

1991
top
1991
Survey form view entire document:  text  image

1. Transcribe from shot record

Immunization: Measles/MMR (shots)

3rd shot:
1[] Measles
2[] MMR
Month ____
Day ____
Year 19____

b. At what age(s) did -- receive (additional) -- vaccine(s)?

A measles or MMR (Measles-Mumps- Rubella) shot?

3rd

1[] Measles
2[] MMR
Age ____
1[] Months
2[] Years