Page:United States Statutes at Large Volume 59 Part 2.djvu/354

 TREATIES International Sanitary Convention for Aerial Navigation, 1944 INTERNATIONAL CERTIFICATE OF VACCINATION AGAINST SMALLPOX THIS IS TO CERTIFY THAT (Age-- Sex - _ ) whose signature appears below has this day been vaccinated by me against smallpox. Origin and Batch No. of vaccine Signature of Vaccinator_ Ofmcial Stamp Official Position Place Date__ Signature of person vaccinated Home address Important Note. In the case of primary vaccination the person vaccinated should be warned to report to a medical practitioner between the 8th and 14th day, in order that the result of the vacci- nation may be recorded on this certificate. In the case of revac- cination the person should report within 48 hours for first inspection in order that any immune reaction which has developed may be recorded. THIS IS TO CERTIFY THAT the above vaccination was inspected by me on the date(s) and with the result(s) shown hereunder: Date of Inspection Result Signature of Doctor Stamp Official Position Place Date Use one or other of the following terms in stating the result, viz: "Reaction of immunity", "Accelerated reaction (vaccinoid)", "Typical primary vaccinia". A certificate of "No reaction" will not be accepted. Signature of person vaccinated (This certificate is not valid for more than 3 years from date of issue.) [59 STAT.

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