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Vaccine Manufacturer Follow-Up Information Sheet - health ny

Vaccine Manufacturer Follow-Up Information Sheet - health ny 2026

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The document outlines the procedures for reporting and managing incidents involving vaccine storage temperature deviations within the New York State Vaccines for Children Program (NYS VFC). It includes sections for documenting incident details, affected vaccines, manufacturer follow-up, and estimated costs of lost vaccines. Providers are instructed to maintain proper storage conditions, contact manufacturers for guidance on affected vaccines, and report to the NYS Department of Health.

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Click ‘Get Form’ to open the Vaccine Manufacturer Follow-Up Information Sheet in the editor.
Begin with Part 1: Incident Description and Temperature Data. Fill in your facility or physician name, phone number, and PIN. Document the incident description clearly, including dates and temperatures for both refrigerator and freezer.
In Part 2: Vaccine Data and Manufacturer Response, list all affected vaccines. Include details such as brand name, manufacturer, lot number, expiration date, and the number of doses affected. Ensure you contact the manufacturer representative for their response.
Complete Part 3: Estimated Cost of Vaccine Loss Report by estimating lost vaccines based on the CDC price list provided. Fill in the total cost of lost vaccines at the end.
Once completed, utilize our platform's features to fax or email the form directly to NYSDOH Bureau of Immunization as instructed.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is the vaccine manufacturer documented in a patients medical record for their vaccination information?

By law, the following information must be documented on the patients paper or electronic medical record (or on a permanent office log): The vaccine manufacturer. The lot number of the vaccine. The date the vaccine is administered.

When would you provide a vaccine information sheet?

Federal law requires that VISs be handed out before each dose of certain vaccinations. The VISs available here are the same versions you would receive if you downloaded them directly from CDC. You are invited (and encouraged) to print and use these as handouts for your patients.

What is the purpose of a VIS document?

A VIS or Vaccine Information Statement is a document, produced by CDC, that informs vaccine recipients or their parents or legal representatives about the benefits and risks of a vaccine they are receiving. Read about the evolution and history of Vaccine Information Statements. About VISs | Vaccines Immunizations - CDC CDC vaccines hcp about-vis CDC vaccines hcp about-vis

What information must be included on a vaccine inventory log?

The ACIP develops recommendations on how to use vaccines to control disease in the United States. The Committees recommendations are forwarded to CDCs Director and once adopted become official CDC policy. These recommendations are then published in CDCs Morbidity and Mortality Weekly Report (MMWR).

What is a vaccine information sheet?

Vaccine Information Statements are information sheets produced by CDC that explain both the benefits and risks of a vaccine to vaccine recipients. In the case of recipients under 18, they are provided to a parent or legal guardian. Federal law requires that VISs be handed out before each dose of certain vaccinations. Vaccine Information Statements (VISs) Overview - Immunize.org Immunize.org Vaccines VISs VISs Immunize.org Vaccines VISs VISs

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What requires the vaccination documentation information?

All vaccines administered should be fully documented in the patients permanent medical record. Health care providers who administer vaccines that are covered by the National Vaccine Injury Compensation Program are required by law to ensure the permanent medical record of the recipient indicates: Date of administration. Vaccine Administration: After Giving Vaccine - CDC CDC vaccines hcp after CDC vaccines hcp after

When should vaccine information statements be given?

The appropriate VIS must be given prior to the vaccination, and must be given prior to each dose of a multi-dose series. It must be given regardless of the age of the recipient. Vaccine Information Statement: Facts About VISs - CDC Centers for Disease Control and Prevention | CDC (.gov) hcp vis about facts-vis Centers for Disease Control and Prevention | CDC (.gov) hcp vis about facts-vis

Vaccine Manufacturer Follow-Up Information Sheet - health ny 2026

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