|
|
 |
The Centers for Disease Control distributes Vaccinia Vaccine to physicians for immunization of laboratory personnel who are working
with orthopox viruses. The vaccine must be administered by or under the supervision of a licensed physician.
To initially receive the vaccine the entire form must be completed and returned along with the FDA form 1572 (Statement of Investigator)
to the address listed below. This 'Request for Vaccinia Vaccine' form must be completed and returned to
CDC for each vial of vaccine required. Each vaccine must be reported on this form to the Drug Service prior to vaccination.
 Microsoft Word
download and complete using Microsoft Word.
 PDF format
download, complete and print form using Adobe Acrobat.
|
|
| |
|
