vaccine incident report free printable template - vfcnevada

State of Nevada Dept of Health and Human Services Nevada State Immunization Program 4150 Technology Way, Suite 210 Carson City, NV 89706 Phone: (775) 6845900 Fax: (775) 6848338 Vaccine Incident Report

How to fill out vaccine incident report

How to fill out 684-8338 vaccine incident report:

1. Begin by obtaining the 684-8338 vaccine incident report form from the appropriate authority or institution.
2. Fill in the required personal information section, including your name, contact details, and any relevant identification numbers.
3. Provide details about the vaccine incident, including the date and time it occurred, the location, and any individuals involved.
4. Use clear and concise language to describe the nature of the incident and any observed symptoms or reactions experienced.
5. Include any additional relevant information, such as the batch number or expiration date of the vaccine.
6. If applicable, provide any details about the medical treatment sought or administered following the incident.
7. Sign and date the form to verify the accuracy of the information provided.
8. Submit the completed form to the appropriate authority or institution, following their specified procedures.

Who needs 684-8338 vaccine incident report?

1. Healthcare professionals: Physicians, nurses, and other medical staff should fill out the 684-8338 vaccine incident report when they encounter any adverse events or incidents related to vaccines. This information is crucial for monitoring vaccine safety and making necessary improvements.
2. Vaccine manufacturers: It is important for vaccine manufacturers to be aware of any incidents or adverse events related to their products. The 684-8338 vaccine incident report helps them collect crucial data and take appropriate actions to ensure the safety and effectiveness of their vaccines.
3. Regulatory authorities: Government agencies and regulatory bodies responsible for overseeing vaccine safety and monitoring require the 684-8338 vaccine incident report to gather data and information to assess the overall vaccine safety profile. This helps in making informed decisions regarding public health and vaccine policies.

Remember, it is essential to follow the specific guidelines and instructions provided by the relevant authority or institution when filling out the 684-8338 vaccine incident report.

People Also Ask about vaccine incident report

What is the purpose of the Vaccine Incident Report?

The Vaccine Incident Report is used to report any incidents or issues regarding the storage and handling of vaccines.

Where should I report a vaccine incident?

You should report a vaccine incident to the State of Nevada Dept of Health and Human Services, specifically the Nevada State Immunization Program.

What information is required in the Vaccine Incident Report?

The report requires information such as the facility name, person reporting, PIN number, telephone number, date reported, current temperature of refrigerator and freezer, date of incident, temperature at the time of incident, description of incident, and steps to prevent future incidents.

What should I do if I suspect an incident has occurred with vaccines?

If you suspect an incident has occurred, do not throw out the affected vaccines and do not assume they are not viable. It is important to complete the Vaccine Incident Report and take appropriate steps to prevent further incidents.

Is it necessary to move vaccines to a working refrigerator/freezer after an incident?

Yes, vaccines should be moved to a working refrigerator or freezer post-incident to ensure their proper storage and integrity.

What is the role of the manufacturer in the incident reporting process?

A report of viability from the manufacturer is required for all affected vaccines. This helps in assessing the impact of the incident and determining the appropriate disposition of the vaccines.

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Quick facts to know before filling out the form

• Department: State of Nevada Dept of Health and Human Services
• Program: Nevada State Immunization Program
• Address: 4150 Technology Way, Suite 210, Carson City, NV 89706
• Phone: (775) 684-5900
• Fax: (775) 684-8338
• Reported by: [Reported by]
• Facility Name: [Facility Name]
• PIN #: [PIN #]
• Telephone #: [Telephone #]
• Date Reported: [Date Reported]
• Current temperature of refrigerator: [Current temperature of refrigerator]
• Max/Min temperature reached: [Max/Min temperature reached]
• Current temperature of freezer: [Current temperature of freezer]
• Max/Min temperature reached: [Max/Min temperature reached]
• Date of incident and refrigerator temperature: [Date of incident and refrigerator temperature]
• Date and time of last recorded temp before incident: [Date and time of last recorded temp before incident]
• Amount of time the temperature was outside normal range: [Amount of time the temperature was outside normal range]
• Vaccines were moved to a working refrigerator/freezer post event: [Vaccines were moved to a working refrigerator/freezer post event]
• Description of incident: [Description of incident]
• Steps to prevent this from happening in the future: [Steps to prevent this from happening in the future]
• Report of viability from manufacturer (required): [Report of viability from manufacturer]
• Details of affected vaccines: [Details of affected vaccines]