The STS-131/19A crew patch highlights the Space Shuttle in the Rendezvous Pitch Maneuver (RPM). This maneuver is heavily photographed by the International Space Station (ISS) astronauts, and the photos are analyzed back on earth to clear the Space Shuttle's thermal protection system for re-entry. The RPM illustrates the teamwork and safety process behind each Space Shuttle launch

In the Space Shuttle's cargo bay is the Multi-Purpose Logistics Module (MPLM), Leonardo, which is carrying several science racks, the last of the four crew quarters, and supplies for the ISS. Out of view and directly behind the MPLM, is the Ammonia Tank Assembly (ATA) that will be used to replace the current ATA. This will take place during three Extra Vehicular Activities (EVAs).

The 51.6 degree Space Shuttle orbit is illustrated by the three gold bars of the astronaut symbol, and its elliptical wreath contains the orbit of the ISS. The star atop the astronaut symbol is the dawning sun, which is spreading its early light across the Earth. The background star field contains seven stars, one for each crewmember; they are proud to represent the United States and Japan during this mission.