NHS COVID Pass - Vaccinated

2D barcode expiry 23 July 2023

Name
Grete Birtwistle To protect your data privacy the 2D barcode
Please check against
expires on the stated expiry date. Please
the bearer's identity. generate a new NHS COVID Pass to renew the
Date of birth
barcode.
22 September 1943

COVID-19 Vaccine Moderna [Booster]

Dose 5 of 5
Date of vaccination 24 September 2022
Vaccine product Spikevax
Manufacturer Moderna Biotech Spain S.L.
Vaccine SARS-CoV-2 mRNA Vaccine
Batch number 200006A
Disease targeted COVID-19
Country of vaccination GB
Issuer NHS Digital
BROCKWAY MEDICAL CENTRE - COVID LOCAL
Administering Centre
VACCINATION SERVICE

This document is important. Keep it safe. It is a PDF copy of your vaccination records.

Page: 1 of 5

Find out about COVID-19 symptoms, testing, vaccination and staying at home on the NHS website: www.nhs.uk/conditions/coronavirus-covid-19

Data Protection: The Department for Health and Social Care (DHSC) is the Data Controller and is responsible for processing your personal data for the purposes of the NHS COVID
Pass Programme. To find out more you can access the DHSC Privacy Notice at: www.gov.uk/government/publications/dhsc-privacy-notice. The NHS COVID Pass Privacy
Notice is available within the guidance at: https://covid-status.service.nhsx.nhs.uk/help/privacy-notice
NHS COVID Pass - Vaccinated

2D barcode expiry 23 July 2023

Name
Grete Birtwistle To protect your data privacy the 2D barcode
Please check against
expires on the stated expiry date. Please
the bearer's identity. generate a new NHS COVID Pass to renew the
Date of birth
barcode.
22 September 1943

Pfizer/BioNTech COVID-19 vaccine [Booster]

Dose 4 of 4
Date of vaccination 24 March 2022
Vaccine product Comirnaty
Manufacturer Biontech Manufacturing GmbH
Vaccine SARS-CoV-2 mRNA Vaccine
Batch number FM3092
Disease targeted COVID-19
Country of vaccination GB
Issuer NHS Digital
BOOTS - HARTCLIFFE - COVID LOCAL VACCINATION
Administering Centre
SERVICE

This document is important. Keep it safe. It is a PDF copy of your vaccination records.

Page: 2 of 5

Find out about COVID-19 symptoms, testing, vaccination and staying at home on the NHS website: www.nhs.uk/conditions/coronavirus-covid-19

Data Protection: The Department for Health and Social Care (DHSC) is the Data Controller and is responsible for processing your personal data for the purposes of the NHS COVID
Pass Programme. To find out more you can access the DHSC Privacy Notice at: www.gov.uk/government/publications/dhsc-privacy-notice. The NHS COVID Pass Privacy
Notice is available within the guidance at: https://covid-status.service.nhsx.nhs.uk/help/privacy-notice
NHS COVID Pass - Vaccinated

2D barcode expiry 23 July 2023

Name
Grete Birtwistle To protect your data privacy the 2D barcode
Please check against
expires on the stated expiry date. Please
the bearer's identity. generate a new NHS COVID Pass to renew the
Date of birth
barcode.
22 September 1943

Pfizer/BioNTech COVID-19 vaccine [Booster]

Dose 3 of 3
Date of vaccination 17 October 2021
Vaccine product Comirnaty
Manufacturer Biontech Manufacturing GmbH
Vaccine SARS-CoV-2 mRNA Vaccine
Batch number FG6431
Disease targeted COVID-19
Country of vaccination GB
Issuer NHS Digital
BROCKWAY MEDICAL CENTRE - COVID LOCAL
Administering Centre
VACCINATION SERVICE

This document is important. Keep it safe. It is a PDF copy of your vaccination records.

Page: 3 of 5

Find out about COVID-19 symptoms, testing, vaccination and staying at home on the NHS website: www.nhs.uk/conditions/coronavirus-covid-19

Data Protection: The Department for Health and Social Care (DHSC) is the Data Controller and is responsible for processing your personal data for the purposes of the NHS COVID
Pass Programme. To find out more you can access the DHSC Privacy Notice at: www.gov.uk/government/publications/dhsc-privacy-notice. The NHS COVID Pass Privacy
Notice is available within the guidance at: https://covid-status.service.nhsx.nhs.uk/help/privacy-notice
NHS COVID Pass - Vaccinated

2D barcode expiry 23 July 2023

Name
Grete Birtwistle To protect your data privacy the 2D barcode
Please check against
expires on the stated expiry date. Please
the bearer's identity. generate a new NHS COVID Pass to renew the
Date of birth
barcode.
22 September 1943

COVID-19 Vaccine AstraZeneca

Dose 2 of 2
Date of vaccination 15 April 2021
Vaccine product Vaxzevria
Manufacturer AstraZeneca AB
Vaccine SARS-CoV-2 Antigen Vaccine
Batch number PW40011
Disease targeted COVID-19
Country of vaccination GB
Issuer NHS Digital
BROCKWAY MEDICAL CENTRE - COVID LOCAL
Administering Centre
VACCINATION SERVICE

This document is important. Keep it safe. It is a PDF copy of your vaccination records.

Page: 4 of 5

Find out about COVID-19 symptoms, testing, vaccination and staying at home on the NHS website: www.nhs.uk/conditions/coronavirus-covid-19

Data Protection: The Department for Health and Social Care (DHSC) is the Data Controller and is responsible for processing your personal data for the purposes of the NHS COVID
Pass Programme. To find out more you can access the DHSC Privacy Notice at: www.gov.uk/government/publications/dhsc-privacy-notice. The NHS COVID Pass Privacy
Notice is available within the guidance at: https://covid-status.service.nhsx.nhs.uk/help/privacy-notice
NHS COVID Pass - Vaccinated

2D barcode expiry 23 July 2023

Name
Grete Birtwistle To protect your data privacy the 2D barcode
Please check against
expires on the stated expiry date. Please
the bearer's identity. generate a new NHS COVID Pass to renew the
Date of birth
barcode.
22 September 1943

COVID-19 Vaccine AstraZeneca

Dose 1 of 2
Date of vaccination 21 January 2021
Vaccine product Vaxzevria
Manufacturer AstraZeneca AB
Vaccine SARS-CoV-2 Antigen Vaccine
Batch number AB0003
Disease targeted COVID-19
Country of vaccination GB
Issuer NHS Digital
BROCKWAY MEDICAL CENTRE - COVID LOCAL
Administering Centre
VACCINATION SERVICE

This document is important. Keep it safe. It is a PDF copy of your vaccination records.

Page: 5 of 5

Find out about COVID-19 symptoms, testing, vaccination and staying at home on the NHS website: www.nhs.uk/conditions/coronavirus-covid-19

Data Protection: The Department for Health and Social Care (DHSC) is the Data Controller and is responsible for processing your personal data for the purposes of the NHS COVID
Pass Programme. To find out more you can access the DHSC Privacy Notice at: www.gov.uk/government/publications/dhsc-privacy-notice. The NHS COVID Pass Privacy
Notice is available within the guidance at: https://covid-status.service.nhsx.nhs.uk/help/privacy-notice