Short-dated vaccine reporting

This page is intended for VFC enrolled providers to report vaccine that will not be used and will expire within 90 days to the NYS VFC Program. Expiring product should be reported within 90 but no less than 60 days before expiration if the product will not be used. Please do not report vaccine that you expect to use before the expiration date.
One vaccine may be entered per response. In the event that you have multiple vaccines, you must complete one response per expiring vaccine lot.

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* 1. Contact information

Practice Name

Contact Person's Name

VFC Pin

Email Address

Phone number

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* 2. Vaccine Trade Name

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* 3. Lot Number

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* 4. Expiration Date

Date:

Date

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* 5. Doses Expiring

Number

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* 1. Contact information

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* 2. Vaccine Trade Name

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* 3. Lot Number

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* 4. Expiration Date

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* 5. Doses Expiring

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* 6. Why have these doses gone unused?