What was the temperature of the storage unit when the problem was discovered? (Write N/A if the excursion was in the Freezer)
(Write N/A if the excursion was in the Freezer)
(Write N/A if the excursion was in the Freezer)
(Write N/A if the excursion was in the Freezer)
What was the temperature of the storage unit when the problem was discovered? (Write N/A if the excursion was in the Refrigerator)
(Write N/A if the excursion was in the Refrigerator)
(Write N/A if the excursion was in the Refrigerator)
(Write N/A if the excursion was in the Refrigerator)
What was the temperature of the room when the problem was discovered?
• General description (i.e., what happened?)
• Estimated length of time between event and last documented reading of storage temperature in acceptable range (36o to 46oF [2° to 8°C] for refrigerator; -58º to 5ºF [-50° to -15°C] for freezer)
• At the time of the event, what else was in the storage unit? For example, were there water bottles in the refrigerator and/or frozen coolant packs in the freezer?
• Prior to this event, have there been any storage problems with this unit and/or with the affected vaccine?
• Include any other information you feel might be relevant to understanding the event.
• When were the affected vaccines placed in proper storage conditions?
• Who was contacted regarding the incident? (For example, supervisor, VFC Program, manufacturer—list all.)
• IMPORTANT: What did you do to prevent a similar problem from occurring in the future?
• What happened to the vaccine?
• Was it able to be used?
If not, was it returned to the distributor?
