Each medical care provider who administers a vaccine set forth in the Vaccine Injury Table [see Appendix 12–A] to any person shall record, or ensure that there is recorded, in such person’s permanent medical record (or in a permanent office log or file to which a legal representative shall have access upon request) with respect to each such vaccine—

1. the date of administration of the vaccine,

2. the vaccine manufacturer and lot number of the vaccine,

3. the name and address and, if appropriate, the title of the medical care provider administering the vaccine, and

4. any other identifying information on the vaccine required pursuant to regulations promulgated by the Secretary.