ALABAMA DEPARTMENT of PUBLIC HEALTH
 
VFC Expired/Spoiled/Wasted Vaccine Report

VFC Expired/Spoiled/Wasted Vaccine Report
If your office uses VTrckS to order your vaccine, please go to http://www.adph.org/Immunization/assets/VTrckS_Vaccine_Returns.pdf to complete the return through VTrckS. If you choose to submit this electronic form, arrangements will be made for the vaccine to be picked up by FedEx or UPS and a label sent for that purpose. Please make a copy of this report BEFORE you click to submit. You must place a copy of the returned vaccine report in the box containing the nonviable vaccine.

* VFC Pin Number

* VFC Provider Name

* Date

* Street Address
Please include city, state, and zipcode.

* Clinic Contact Person

* E-mail address

* Phone Number

* How would you like to receive your label(s)?

Standard mail Pick-up Email

* How many labels do you need?
One label per box that you will be shipping your vaccine back to McKesson.

* Vaccine #1 Name and Manufacturer

* Reason for Return

* NDC #

* Lot #

* Expiration Date

* Number of Doses

Please enter the same required information for additional returned vaccines.

Vaccine #2 Name and Manufacturer

Reason for Return

NDC #

Lot #

Expiration Date

Number of Doses

* What happened to the vaccine being returned?

* How will this be prevented next time?

Please print this page by using the "Ctrl P" function and place the page in the box with the returned vaccine.

Do you have another vaccine to add to the list?

Yes  
No