Adverse Storage Condition Report Form Search Submit Search Print this Page Home » For Professionals » Vaccine Ordering & Guidance » Annual Fridge Inspection » Adverse Storage Condition Report Form What is a cold chain break? When you suspect that vaccine has been exposed to temperatures below +2ºC or above +8ºC. Vaccines may become ineffective if the vaccine fridge temperature readings are below +2ºC and/or above +8ºC for any length of time. If these vaccines are administered to a patient, they may cause a localized reaction as well as not provide the protection needed. If you suspect or know you’ve had a cold chain break: Do not use and do not discard any of the exposed vaccines at this time. Place all of the vaccines in a labelled container (or bag), marked with the date and time and “DO NOT USE.” Call the public health unit immediately to report the vaccine exposure. 1-800-660-5853 on voice recognition request “Cold Chain”. We need the following information asap in order to determine if you are still able to use the vaccines, or if they need to be disposed of. Number of vials, lot number and expiration date for all publically funded vaccines in the affected vaccine fridge Recent temperature logs – at least 2 weeks – so we can see patterns of temperatures over time Where is the vaccine now? Back in the fridge, another vaccine fridge? To provide us with this information please fill out this online form below. If you have questions, or need assistance, please contact us at [email protected]. The sooner we receive this information, the sooner we can let you know if your vaccines are still viable and may be used. You may need to cancel appointments for vaccinations as we are not able to immediately replace your vaccine supply. Practice Location(Required) Almonte/Carleton Place/Pakenham Perth/Lanark/Westport Smiths Falls/Jasper Kemptville/Merrickville Brockville Leeds/Grenville/Seaway Areas Please Select Your Holding Point Number - see yellow sticker on vaccine fridge(Required)***Please select your Holding Point Number***LGL_BR_00036 - Ottawa Valley Family Health TeamLGL_BR_00083 - Almonte Country HavenLGL_BR_00037 - Almonte General HospitalLGL_BR_00224 - Occ Health Almonte General HospitalLGL_BR_00094 - Rexall Pharma Plus - AlmonteLGL_BR_00094 - Rexall Pharma Plus Fridge 2 - AlmonteLGL_BR_00091 - Almonte RemedysRXLGL_BR_00092 - Shoppers Drugmart - AlmonteLGL_BR_00208 - Almonte Pharmacy and Health CentreLGL_BR_00038 - Fairview ManorLGL_BR_00168 - Orchard View Gardens IncLGL_BR_00079 - Carleton Place and District HospitalLGL_BR_00225 - Occ Health Carleton Place and District Memorial HospitalLGL_BR_00085 - Stoneridge ManorLGL_BR_00140 - Carleton Place Terrace by Symphony Senior LivingLGL_BR_00151 - The Waterside Retirement CommunityLGL_BR_00226 - OVFHT Carleton PlaceLGL_BR_00102 - Carleton Place IDA DrugmartLGL_BR_00104 - Shoppers Drugmart - Carleton PlaceLGL_BR_00105 - DrugStore Pharmacy - Carleton PlaceLGL_BR_00106 - Walmart Pharmacy - Carleton PlaceLGL_BR_00209 - Seaway Valley Pharmacy - Carleton PlaceLGL_BR_00212 - Mona's Pharmacy - Carleton PlaceLGL_BR_00166 - Pakenham PharmacyIf you don’t see your holding point location in the list, please email [email protected]Please Select Your Holding Point Number - see yellow sticker on vaccine fridge(Required)***Please select your Holding Point Number***LGL_BR_00069 - Perth HospitalLGL_BR_00080 - Lanark LodgeLGL_BR_00084 - Perth Community CareLGL_BR_00195 - Tay River Health CentreLGL_BR_00206 - Tay River Medical PharmacyLGL_BR_00062 - Perth Family MedicineLGL_BR_00183 - Carolina Retirement ResidenceLGL_BR_00193 - Lanark Lifestyles Retirement ResidenceLGL_BR_00090 - Algonquin College - PerthLGL_BR_00134 - 3M Perth Canada CompanyLGL_BR_00065 - Elliot Street ClinicLGL_BR_00221 - Perth Family Health TeamLGL_BR_00061 - Perth Medical Fridge ALGL_BR_00063 - Perth Medical Fridge BLGL_BR_00057 - ConnectWell Community HealthLGL_BR_00115 - Perth Downtown PharmasaveLGL_BR_00116 - Shoppers Drugmart - PerthLGL_BR_00116 - Shoppers Drugmart Fridge 2 - PerthLGL_BR_00184 - Perth Family PharmacyLGL_BR_00194 - Perth Mews PharmacyLGL_BR_00127 - Country Roads CHC - Westport LocationLGL_BR_00126 - Westport Village PharmacyLGL_BR_00165 - Lanark Medical PharmacyIf you don’t see your holding point location in the list, please email [email protected]Please Select Your Holding Point Number - see yellow sticker on vaccine fridge(Required)***Please select your Holding Point Number***LGL_BR_00088 - Rosebridge ManorLGL_BR_00175 - Lanark County Community ParamedicLGL_BR_00218 - Cornelia Court Family Medicine - Fridge 1LGL_BR_00137 - Bayshore Healthcare - SFLGL_BR_00068 - Smiths Falls HospitalLGL_BR_00081 - Broadview Nursing CentreLGL_BR_00072 - Smiths Falls NPLCLGL_BR_00070 - Robin Conway, MDLGL_BR_00067 - RCHS Smiths FallsLGL_BR_00124 – Loblaw Pharmacy - Smiths FallsLGL_BR_00132 – Rexall 521 - Smiths FallsLGL_BR_00121 – Rexall Pharma Plus - Smiths FallsLGL_BR_00123 – Shoppers Drug Mart - Smiths FallsLGL_BR_00207 – Smiths Falls Drug MartLGL_BR_00191 – Smiths Falls Family PharmacyLGL_BR_00125 – Walmart Pharmacy - Smiths FallsIf you don’t see your holding point location in the list, please email [email protected]Please Select Your Holding Point Number - see yellow sticker on vaccine fridge(Required)***Please select your Holding Point Number***LGL_BR_00051 - Dr. Leahy / Dr. Brito-VianaLGL_BR_00052 - Mira Abdel-Malek, MD / Dr. Phambri-KomalLGL_BR_00053 - Luong & WanesLGL_BR_00054 - Rideau Crossing FHCLGL_BR_00055 - Kemptville District HospitalLGL_BR_00059 - Hilltop ManorLGL_BR_00213 - Southbridge Care Kemptville - LTCLGL_BR_00177 - Kemptville Health and Wellness CentreLGL_BR_00109 - Shoppers Drugmart - KemptvilleLGL_BR_00110 - Loblaw Pharmacy - KemptvilleLGL_BR_00111 - Walmart Pharmacy - KemptvilleLGL_BR_00112 - Equinelle Pharmasave - KemptvilleLGL_BR_00161 - Kemptville Drug Mart Remedy's RXLGL_BR_00192 - Kemptville Wellness PharmacyLGL_BR_00202 - Kemptville Medical PharmacyLGL_BR_00056 - Merrickville Family MedicineLGL_BR_00210 - Bayfield Retirement CommunityLGL_BR_00058 - RCHS MerrickvilleLGL_BR_00114 - Merrickville Drug MartLGL_BR_00205 - Merrickville PharmacyIf you don’t see your holding point location in the list, please email [email protected]Please Select Your Holding Point Number - see yellow sticker on vaccine fridge(Required)***Please select your Holding Point Number***LGL_BR_00033 - Brockville JailLGL_BR_00017 - Home Street Family PracticeLGL_BR_00019 - Cornerstone Family MedicalLGL_BR_00028 - LGCFHT - BrockvilleLGL_BR_00138 - Bayshore Health Care - BrockvilleLGL_BR_00170 - BV CarePartnersLGL_BR_00026 - Brockville Mental Health CentreLGL_BR_00032 - Brockville General HospitalLGL_BR_00223 - BGH Obstetrics & GynecologyLGL_BR_00030 - St. Lawrence LodgeLGL_BR_00031 - Sherwood Park ManorLGL_BR_00216 - Care & Co.LGL_BR_00015 - Harvinder Chawla, MDLGL_BR_00013 - Dr. HollaLGL_BR_00014 - Chelsea Court Health CentreLGL_BR_00021 - Brockville Family Medical CentreLGL_BR_00018 - Sandra Best, MDLGL_BR_00023 - Samreen Riyaz, MDLGL_BR_00024 - Dr. E TorresLGL_BR_00182 - Dr. Nahbeel PremjiLGL_BR_00139 - Bridlewood Manor by ReveraLGL_BR_00020 - Dr. Jeewanjit GillLGL_BR_00034 - Brockville Dialysis ClinicLGL_BR_00133 - 3M Canada BrockvilleLGL_BR_00095 - Rexall BrockvilleLGL_BR_00097 - Walmart Pharmacy - BrockvilleLGL_BR_00099 - DrugStore Pharmacy - BrockvilleLGL_BR_00100 - Shoppers Drugmart - BrockvilleLGL_BR_00160 - Parkedale Pharmacy - BrockvilleLGL_BR_00179 - Leeds Pharmacy - BrockvilleIf you don’t see your holding point location in the list, please email [email protected]Please Select Your Holding Point Number - see yellow sticker on vaccine fridge(Required)***Please select your Holding Point Number***LGL_BR_00027 - Athens District Family Health TeamLGL_BR_00164 - Athens PharmasaveLGL_BR_00029 - Maple View LodgeLGL_BR_00075 - Country Roads CHCLGL_BR_00201 - Leeds Grenville Paramedic ServicesLGL_BR_00046 - Stone's Mill FHCLGL_BR_00048 - LGCFHT - GananoqueLGL_BR_00107 - Thousand Islands Pharmacy - GananoqueLGL_BR_00200 - Gananoque IDA PharmacyLGL_BR_00113 - Lansdowne PharmasaveLGL_BR_00077 - Seeley's Bay Medical ClinicLGL_BR_00158 - Seeley's Bay Drug MartLGL_BR_00078 - St. Lawrence & District Medical CentreLGL_BR_00049 - Carveth Care CentreLGL_BR_00204 - FoxRun by the River Retirement ResidenceLGL_BR_00076 - Prescott Family Medical CentreLGL_BR_00118 - Shoppers Drug Mart - PrescottLGL_BR_00119 - Prescott Remedys RXLGL_BR_00120 - Seaway Valley Pharmacy - PrescottLGL_BR_00087 - Wellington HouseLGL_BR_00220 - The Mayfield Retirement ResidenceLGL_BR_00219 - Cardinal Drug MartLGL_BR_00101 - Rexall Pharma Plus - CardinalLGL_BR_00167 - Elgin DrugsLGL_BR_00189 - Mallorytown Pharmacy & Health CentreLGL_BR_00198 - Portland PharmasaveLGL_BR_00199 - Spencerville PharmasaveIf you don’t see your holding point location in the list, please email [email protected]Date Report Completed (yyyy/mm/dd)(Required)Report Completed By(Required) First Name Last Name Telephone Number(Required)ExtensionEmail Address(Required) Incident LocationFacility Name(Required)Facility Contact(Required) Same as above Different than above Facility Contact Name(Required) First Name Last Name Facility Contact Telephone Number(Required)Facility Contact Telephone Number ExtensionFacility Contact Email Address(Required) Premises Type(Required) Physician Office (FP solo) Physician Office (Ped solo) Physician Office (FP group) Physician Office (Ped group) Community Health Centre Correctional Facility First Nations Facility Hospital Long-Term Care Home Nursing Agency Occupational Health Public Health Unit Pharmacy Retirement Home School Other Other Premises Type(Required)Do you have more than one fridge?(Required) Yes No Which fridge is affected?(Required)Incident DescriptionDate of last known temperature consistently between +2 degrees Celsius to +8 degrees Celsius (yyyy/mm/dd)(Required)Time of last known temperature consistently between +2 degrees Celsius to +8 degrees Celsius (hh:mm)(Required)Date of Incident (yyyy/mm/dd)(Required)Time of Incident Discovered (hh:mm)(Required)Temperature at Time of Incident(Required)MinimumMaximumCurrentPlease provide Minimum, Maximum and Current TemperatureEstimated Duration of Exposure (hours)(Required)Where is the vaccine located now?(Required) Back in the vaccine fridge, temperatures have stabilized In a different vaccine fridge In the cooler Other Other - Please describe(Required)For multiple incidents please describe the event including date and time of incident(s), temperature at time of incident(s) and estimated duration of exposure(s).Event Information(Required) Power Failure Fridge Malfunction (e.g. sensor, compressor) Equipment Malfunction (e.g. thermometer, alarm) Human Error (e.g. fridge door left open, fridge unplugged) Other (describe) How long was the power disrupted?(Required)What was the cause of the disruption(Required)What time of day was the disruption(Required)Other Event Information(Required)Vaccine InventoryWhich type of vaccine Influenza (Flu) Vaccine COVID-19 Vaccine RSV Vaccine/mAB Rabies Publically Funded Vaccine Influenza (Flu) Vaccine Trivalent Vaccine High Dose Trivalent Vaccine COVID-19 Vaccine Pfizer-BioNTech Corminarty Moderna Spikevax RSV Vaccine/mAB Abreyvso Beyfortus Arexvy Rabies Vaccine Immune Globulin Publically Funded Vaccine Act-Hib® Adacel® Adacel® -Polio Bexsero® Boostrix® Boostrix® -Polio Engerix B® Adolescent/Adult Engerix B® Pediatric Engerix B® Dialysis Gardasil® 9 Havrix® Adult Havrix® Pediatric Imovax® Polio Imovax® Rabies Menactra® Menjugate® Menveo® Nimenrix® MMR® II NeisVac-C® Pediacel® Pentacel Pneumovax® 20 Prevnar® 15 Priorix® Priorix-Tetra™ ProQuad® Recombivax HB® Adolescent/Adult Recombivax HB® Pediatric Recombivax HB® Renal Rotarix® Shingrix® Td Adsorbed Td Polio Tubersol® Vaqta Adult Vaqta Pediatric Varilix® Varivax® III Other Vaccine Not Listed Act-Hib®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $46.00 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysAct-Hib® Total Number of DosesValue of Returned Act-Hib® VaccinesAdacel®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $38.55 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysAdacel® Total Number of DosesValue of Returned Adacel® VaccinesAdacel® -PolioNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $52.79 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysAdacel® -Polio Total Number of DosesValue of Returned Adacel® -Polio VaccinesBexsero®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $109.64 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysBexsero® Total Number of DosesValue of Returned Bexsero® VaccinesBoostrix®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $30.74 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysBoostrix® Total Number of DosesValue of Returned Boostrix® VaccinesBoostrix® -PolioNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $37.06 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysBoostrix® -Polio Total Number of DosesValue of Returned Boostrix® -Polio VaccinesEngerix B® Adolescent/AdultNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $24.01 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysEngerix B® Adolescent/Adult Total Number of DosesValue of Returned Engerix B® Adolescent/Adult VaccinesEngerix B® PediatricNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $11.39 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysEngerix B® Pediatric Total Number of DosesValue of Returned Engerix B® Pediatric VaccinesEngerix B® DialysisNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePlease provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysGardasil® 9Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $170.87 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysGardasil® 9 Total Number of DosesValue of Returned Gardasil® 9 VaccinesHavrix® AdultNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $49.37 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysHavrix® Adult Total Number of DosesValue of Returned Havrix® Adult VaccinesHavrix® PediatricNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $24.68 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysHavrix® Pediatric Total Number of DosesValue of Returned Havrix® Pediatric VaccinesImovax® PolioNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $47.00 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysImovax® Polio Total Number of DosesValue of Returned Imovax® Polio VaccinesImovax® RabiesNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $207.65 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysImovax® Rabies Total Number of DosesValue of Returned Imovax® Rabies VaccinesMenactra®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $105.30 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysMenactra® Total Number of DosesValue of Returned Menactra® VaccinesMenjugate®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $36.74 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysMenjugate® Total Number of DosesValue of Returned Menjugate® VaccinesMenveo®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $107.21 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysMenveo® Total Number of DosesValue of Returned Menveo® VaccinesNimenrix®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $99.48 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysNimenrix® Total Number of DosesValue of Returned Nimenrix® VaccinesMMR® IINumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $34.33 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysMMR® II Total Number of DosesValue of Returned MMR® II VaccinesNeisVac-C®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $80.19 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysNeisVac-C® Total Number of DosesValue of Returned NeisVac-C® VaccinesPediacel®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $55.02 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysPediacel® Total Number of DosesValue of Returned Pediacel® VaccinesPentacelNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePlease provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysPentacel Total Number of DosesPneumovax® 20Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $24.97 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysPneumovax® 20 Total Number of DosesValue of Returned Pneumovax® VaccinesPrevnar® 15Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $99.02 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysPrevnar® 15 Total Number of DosesValue of Returned Prevnar® 15 VaccinesPriorix®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $29.32 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysPriorix® Total Number of DosesValue of Returned Priorix® VaccinesPriorix-Tetra™Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $96.70 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysPriorix-Tetra™ Total Number of DosesValue of Returned Priorix-Tetra™ VaccinesProQuad®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $116.17 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysProQuad® Total Number of DosesValue of Returned ProQuad® VaccinesRecombivax HB® Adolescent/AdultNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $22.54 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysRecombivax HB® Adolescent/Adult Total Number of DosesValue of Returned Recombivax HB® Adolescent/Adult VaccinesRecombivax HB® PediatricNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $11.40 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysRecombivax HB® Pediatric Total Number of DosesValue of Returned Recombivax HB® Pediatric VaccinesRecombivax HB® RenalNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $184.80 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysRecombivax HB® Renal Total Number of DosesValue of Returned Recombivax HB® Renal VaccinesRotarix®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $88.16 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysRotarix® Total Number of DosesValue of Returned Rotarix® VaccinesShingrix®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $129.20 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysShingrix® Total Number of DosesValue of Returned Shingrix® VaccinesTd AdsorbedNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $22.56 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysTd Adsorbed Total Number of DosesValue of Returned Td Adsorbed VaccinesTd PolioNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $61.55 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysTd Polio Total Number of DosesValue of Returned Td Polio VaccinesTubersol®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $39.60 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysTubersol® Total Number of DosesValue of Returned Tubersol® VaccinesVaqta AdultNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePlease provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysVaqya PediatricNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePlease provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysVarilix®Number of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $61.56 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysVarilix® Total Number of DosesValue of Returned Varilix® VaccinesVarivax® IIINumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePrice per dose: $81.85 Please provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysVarivax® III Total Number of DosesValue of Returned Varivax® III VaccinesTrivalent VaccineNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePlease provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysTrivalent Total Number of DosesHigh Dose Trivalent VaccineNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePlease provide Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd), and Previous Exposure (Yes/No) to avoid any delaysHigh Dose Trivalent Total Number of DosesPfizer-BioNTech CorminartyNumber of DosesLot NumberDate Out of Freezer (yyyy/mm/dd) Add RemovePlease provide Number of Doses, Lot Number, and Date Out of Freezer (yyyy/mm/dd) to avoid any delaysModerna SpikevaxNumber of DosesLot NumberDate Out of Freezer (yyyy/mm/dd) Add RemovePlease provide Number of Doses, Lot Number, and Date Out of Freezer (yyyy/mm/dd) to avoid any delaysAbreyvsoNumber of DosesLot NumberDate Out of Freezer (yyyy/mm/dd) Add RemovePlease provide Number of Doses, Lot Number, and Date Out of Freezer (yyyy/mm/dd) to avoid any delaysBeyfortusNumber of DosesLot NumberDate Out of Freezer (yyyy/mm/dd) Add RemovePlease provide Number of Doses, Lot Number, and Date Out of Freezer (yyyy/mm/dd) to avoid any delaysArexvyNumber of DosesLot NumberDate Out of Freezer (yyyy/mm/dd) Add RemovePlease provide Number of Doses, Lot Number, and Date Out of Freezer (yyyy/mm/dd) to avoid any delaysRabies VaccineNumber of DosesLot NumberDate Out of Freezer (yyyy/mm/dd) Add RemovePlease provide Number of Doses, Lot Number, and Date Out of Freezer (yyyy/mm/dd) to avoid any delaysImmune GlobulinNumber of DosesLot NumberDate Out of Freezer (yyyy/mm/dd) Add RemovePlease provide Number of Doses, Lot Number, and Date Out of Freezer (yyyy/mm/dd) to avoid any delaysOther Vaccine Not ListedName of VaccineNumber of DosesLot NumberExpiry Date (yyyy/mm/dd)Previous Exposure (Yes/No) Add RemovePlease provide Name of Vaccine, Number of Doses, Lot Number, Expiry Date (yyyy/mm/dd) and Previous Exposure (Yes/No) to avoid any delaysTotal Value of all Returned VaccinesThis field is hidden when viewing the formHealth Unit Use OnlyThis field is hidden when viewing the formClient IDThis field is hidden when viewing the formMost Recent Fridge Inspection Date (yyyy/mm/dd)This field is hidden when viewing the formDetected on Annual Fridge InspectionThis field is hidden when viewing the formDate Public Health Unit Notified (yyyy/mm/dd)This field is hidden when viewing the formHolding Point NumberThis field is hidden when viewing the formFridge NumberThis field is hidden when viewing the formASC Number for PanoramaThis field is hidden when viewing the formStaff Member Who Initiated ASCThis field is hidden when viewing the formComments (MFR Reference Numbers If Info is Pending from MFR)CAPTCHA