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Childhood Immunization Record

Overview

My child's name is __________________________. My child's birthday is _________________.

My child's doctor is __________________________. The doctor's phone number is _____________________.

Age	Immunization	Dose	Notes
Birth	Hepatitis B (HepB)	1 of 3

2 months	Diphtheria, tetanus, and pertussis (DTaP)	1 of 5
	Haemophilus influenzae type b (Hib)	1 of 4
	Hepatitis B (HepB)	2 of 3	Can be given from 1 to 2 months of age
	Pneumococcal (PCV)	1 of 4
	Polio (IPV)	1 of 4
	Rotavirus	1 of 2 or 3

4 months	DTaP	2 of 5
	Haemophilus influenzae type b (Hib)	2 of 4
	Pneumococcal (PCV)	2 of 4
	Polio (IPV)	2 of 4
	Rotavirus	2 of 2 or 3

6 months	DTaP	3 of 5
	Haemophilus influenzae type b (Hib)	3 of 4
	Hepatitis B (HepB)	3 of 3	Can be given from 6 to 18 months of age
	Pneumococcal (PCV)	3 of 4
	Polio (IPV)	3 of 4	Can be given from 6 to 18 months of age
	Rotavirus	3 of 3, if needed

6 months and older	Flu (influenza)	Yearly	One dose each year. Children younger than 9 years of age may need 2 doses depending on when they started getting this yearly immunization.

12 months	Chickenpox (varicella)	1 of 2	Can be given from 12 to 15 months of age
	Haemophilus influenzae type b (Hib)	4 of 4	Can be given from 12 to 15 months of age
	Hepatitis A (HepA)	1 of 2	Can be given from 12 to 23 months of age
	Measles, mumps, rubella (MMR)	1 of 2	Can be given from 12 to 15 months of age
	Pneumococcal (PCV)	4 of 4	Can be given from 12 to 15 months of age

15 months	DTaP	4 of 5	Can be given from 15 to 18 months of age Can be given from 12 months of age, if at least 6 months after the 3rd dose

18 months	Hepatitis A (HepA)	2 of 2	Given at least 6 months after the 1st dose

4 years	Chickenpox (varicella)	2 of 2	Given at 4 to 6 years of age; can be given earlier, if at least 3 months after the 1st dose
	DTaP	5 of 5	Can be given from 4 to 6 years of age
	MMR	2 of 2	Can be given from 4 to 6 years of age
	Polio (IPV)	4 of 4	Can be given from 4 to 6 years of age

9 years and older	Human papillomavirus (HPV)	1, 2, or 3	Given at 9 to 14 years of age. Two doses are given within 6 months. A three-dose series is given at 15 years or older.
	Meningococcal	1 and 2	Preferred given at 11 or 12 years of age. A second dose given at age 16. Teens ages 13 to 18 who haven't had the shot should get it as soon as possible.
	Tetanus, diphtheria, pertussis (Tdap)	1 of 1	Given at 11 or 12 years of age. Teens who haven't had the shot should get it as soon as possible.

Other shots

Depending on where you live and your child's health, your doctor may recommend other shots. Talk to your doctor about whether your child needs any of the following shots.

Age	Immunization	Notes
2 years and older	Hepatitis A (HepA)	Your child may need this shot if he or she has not already had the vaccination series and: Hepatitis A is found in your area. You and your child travel to countries with a high rate of hepatitis A. These include Mexico and countries in Central or South America, the Caribbean, Asia (except Japan), Africa, and eastern Europe. Your child needs medicine to help the blood clot. Others at risk for hepatitis A include people who use "street" drugs, men who have sex with men, and people who work with animals that have the disease or who work with the hepatitis A virus in a lab. If your child has contact with these groups of people, your child may also be at risk. Two shots are given. The two shots must be at least 6 months apart.
2 years and older	Pneumococcal (PPSV)	Your child may need this pneumococcal shot when older than age 2 if he or she: Has sickle cell disease. Has a damaged spleen or has had the spleen removed. Has a disease or condition that affects the immune system, such as diabetes or HIV. Takes medicine that affects the immune system, such as chemotherapy or corticosteroids. Has a long-lasting disease, such as heart disease, lung disease, kidney disease, or diabetes.
6 weeks to 10 years	Meningococcal	Your child may need at least 2 shots before age 11 if he or she: Is in an area where an outbreak has occurred. Has a damaged spleen or has had the spleen removed. Has certain immune system problems. Travels or lives in areas of the world where meningococcal disease is common, such as certain parts of Africa or Saudi Arabia during the Hajj. Talk to your doctor about whether booster shots are needed.

Age

Immunization

Notes

2 years and older

Hepatitis A (HepA)

Your child may need this shot if he or she has not already had the vaccination series and:

Hepatitis A is found in your area.
You and your child travel to countries with a high rate of hepatitis A. These include Mexico and countries in Central or South America, the Caribbean, Asia (except Japan), Africa, and eastern Europe.
Your child needs medicine to help the blood clot.

Others at risk for hepatitis A include people who use "street" drugs, men who have sex with men, and people who work with animals that have the disease or who work with the hepatitis A virus in a lab. If your child has contact with these groups of people, your child may also be at risk.

Two shots are given. The two shots must be at least 6 months apart.

2 years and older

Pneumococcal (PPSV)

Your child may need this pneumococcal shot when older than age 2 if he or she:

Has sickle cell disease.
Has a damaged spleen or has had the spleen removed.
Has a disease or condition that affects the immune system, such as diabetes or HIV.
Takes medicine that affects the immune system, such as chemotherapy or corticosteroids.
Has a long-lasting disease, such as heart disease, lung disease, kidney disease, or diabetes.

6 weeks to 10 years

Meningococcal

Your child may need at least 2 shots before age 11 if he or she:

Is in an area where an outbreak has occurred.
Has a damaged spleen or has had the spleen removed.
Has certain immune system problems.
Travels or lives in areas of the world where meningococcal disease is common, such as certain parts of Africa or Saudi Arabia during the Hajj.

Talk to your doctor about whether booster shots are needed.

Missed doses: If your child has missed any shots, talk to your doctor about the best way to make them up.

Travel: If you are traveling or if you live outside of the United States, your child may need other shots. Talk to your doctor several months before your trip.

Availability: Shots may sometimes not be available or may be in short supply. In this case, talk with your doctor about the best thing to do for your child.

Reactions: List any reactions your child has had to vaccines.

Print out a copy of your child's schedule and keep it up to date. It is very important to keep accurate records of your child's shots. When you enroll your child in day care or school, you may need to show proof of immunizations. Also, your child may need the record later in life for college, employment, or travel. Take the schedule with you when you visit your doctor. Your doctor may need to change the schedule based on your child's special needs. Keep the record in a safe place with other important documents, and never throw it away. It is an important part of your child's lifelong medical records.

Put notes on your calendar to remind you when a shot is coming up. You also may want to ask your doctor to send you notices when shots are due.

This information is based on the immunization schedule recommended by the Advisory Committee on Immunization Practices (ACIP) and other medical organizations. It is based on your child's birth date. The schedule is available from the U.S. Centers for Disease Control and Prevention website at www.cdc.gov/vaccines/schedules/index.html.

Some diseases or treatments for disease affect the immune system. For children with these diseases or children receiving these treatments, the schedule may need to be modified. Your child's health, environment, and lifestyle may also affect the shot schedule. Always talk to your doctor about the best schedule for your child.

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Credits

Current as of: April 30, 2024

Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

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Related Information

Current as of: April 30, 2024

Author: Ignite Healthwise, LLC Staff

Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

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