"Fahrenheit Temperature Log for Refrigerator (Vaccine Storage) - Immunization Action Coalition"

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Temperature Log for Refrigerator – Fahrenheit
F
Month
/
Year
VFC PIN or other ID #
°
Page 1 of 3
DAYS 1 – 15
Facility Name
Monitor temperatures closely!
Take action if temp is out of range – too warm (above 46ºF) or too cold (below 36ºF).
1. W rite your initials below in “Staff Initials,” and note the time in “Exact Time.”
1. L abel exposed vaccine “do not use,” and store it under proper conditions as quickly as possible.
2. R ecord temps twice each workday.
Do not discard vaccines unless directed to by your state/local health department and/or the
3. R ecord the min/max temps once each workday – preferably in the morning.
manufacturer(s).
4. P ut an “X” in the row that corresponds to the refrigerator’s temperature.
2. R ecord the out-of-range temps and the room temp in the “Action” area on the bottom of the log.
5. If any out-of-range temp, see instructions to the right.
3. N otify your vaccine coordinator, or call the immunization program at your state or local health
6. A fter each month has ended, save each month’s log for 3 years, unless state/local
department for guidance.
jurisdictions require a longer period.
4. D ocument the action taken on the “Vaccine Storage Troubleshooting Record” on page 3.
Day of Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Staff Initials
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
Exact Time
Min/Max Temp
(since previous reading)
Danger! Temperatures above 46ºF are too warm! Write any out-of-range temps and room temp on the lines below and call your state or local health department immediately!
˚
46
F
˚
45
F
˚
44
F
˚
43
F
˚
42
F
41
˚
F
Aim for 40
˚
º
40
F
˚
39
F
38
˚
F
˚
37
F
˚
36
F
Danger! Temperatures below 36ºF are too cold! Write any out-of-range temps and room temp on the lines below and call your state or local health department immediately!
Write any out-of-range
temps (above 46ºF
or below 36ºF) here:
Room Temperature
If you have a vaccine storage issue, also complete “Vaccine Storage Troubleshooting Record” found on page 3.
Adapted with appreciation from California Department of Public Health
Technical content reviewed by the Centers for Disease Control and Prevention
Immunization Action Coalition
651 - 647 - 9009
Saint Paul, Minnesota
www.immunize.org
www.vaccineinformation.org
www.immunize.org/catg.d/p3037F.pdf
Item #P3037F (8/16)
Temperature Log for Refrigerator – Fahrenheit
F
Month
/
Year
VFC PIN or other ID #
°
Page 1 of 3
DAYS 1 – 15
Facility Name
Monitor temperatures closely!
Take action if temp is out of range – too warm (above 46ºF) or too cold (below 36ºF).
1. W rite your initials below in “Staff Initials,” and note the time in “Exact Time.”
1. L abel exposed vaccine “do not use,” and store it under proper conditions as quickly as possible.
2. R ecord temps twice each workday.
Do not discard vaccines unless directed to by your state/local health department and/or the
3. R ecord the min/max temps once each workday – preferably in the morning.
manufacturer(s).
4. P ut an “X” in the row that corresponds to the refrigerator’s temperature.
2. R ecord the out-of-range temps and the room temp in the “Action” area on the bottom of the log.
5. If any out-of-range temp, see instructions to the right.
3. N otify your vaccine coordinator, or call the immunization program at your state or local health
6. A fter each month has ended, save each month’s log for 3 years, unless state/local
department for guidance.
jurisdictions require a longer period.
4. D ocument the action taken on the “Vaccine Storage Troubleshooting Record” on page 3.
Day of Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Staff Initials
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
Exact Time
Min/Max Temp
(since previous reading)
Danger! Temperatures above 46ºF are too warm! Write any out-of-range temps and room temp on the lines below and call your state or local health department immediately!
˚
46
F
˚
45
F
˚
44
F
˚
43
F
˚
42
F
41
˚
F
Aim for 40
˚
º
40
F
˚
39
F
38
˚
F
˚
37
F
˚
36
F
Danger! Temperatures below 36ºF are too cold! Write any out-of-range temps and room temp on the lines below and call your state or local health department immediately!
Write any out-of-range
temps (above 46ºF
or below 36ºF) here:
Room Temperature
If you have a vaccine storage issue, also complete “Vaccine Storage Troubleshooting Record” found on page 3.
Adapted with appreciation from California Department of Public Health
Technical content reviewed by the Centers for Disease Control and Prevention
Immunization Action Coalition
651 - 647 - 9009
Saint Paul, Minnesota
www.immunize.org
www.vaccineinformation.org
www.immunize.org/catg.d/p3037F.pdf
Item #P3037F (8/16)
Temperature Log for Refrigerator – Fahrenheit
F
°
Month
/
Year
VFC PIN or other ID #
Page 2 of 3
DAYS 16 – 31
Facility Name
Monitor temperatures closely!
Take action if temp is out of range – too warm (above 46ºF) or too cold (below 36ºF).
1. W rite your initials below in “Staff Initials,” and note the time in “Exact Time.”
1. L abel exposed vaccine “do not use,” and store it under proper conditions as quickly as possible.
2. R ecord temps twice each workday.
Do not discard vaccines unless directed to by your state/local health department and/or the
3. R ecord the min/max temps once each workday – preferably in the morning.
manufacturer(s).
4. P ut an “X” in the row that corresponds to the refrigerator’s temperature.
2. R ecord the out-of-range temps and the room temp in the “Action” area on the bottom of the log.
5. If any out-of-range temp, see instructions to the right.
3. N otify your vaccine coordinator, or call the immunization program at your state or local health
6. A fter each month has ended, save each month’s log for 3 years, unless state/local
department for guidance.
jurisdictions require a longer period.
4. D ocument the action taken on the “Vaccine Storage Troubleshooting Record” on page 3.
Day of Month
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Staff Initials
am pm
am pm
am pm
am pm
am pm
am pm
am pm
am pm
am pm
am pm
am pm
am pm
am pm
am pm
am pm
am pm
Exact Time
Min/Max Temp
(since previous reading)
Danger! Temperatures above 46ºF are too warm! Write any out-of-range temps and room temp on the lines below and call your state or local health department immediately!
˚
46
F
˚
45
F
˚
44
F
˚
43
F
˚
42
F
˚
41
F
˚
Aim for 40
º
40
F
˚
39
F
˚
38
F
˚
37
F
36
˚
F
Danger! Temperatures below 36ºF are too cold! Write any out-of-range temps and room temp on the lines below and call your state or local health department immediately!
Write any out-of-range
temps (above 46ºF
or below 36ºF) here:
Room Temperature
If you have a vaccine storage issue, also complete “Vaccine Storage Troubleshooting Record” found on page 3.
Adapted with appreciation from California Department of Public Health
Technical content reviewed by the Centers for Disease Control and Prevention
Immunization Action Coalition
651 - 647 - 9009
Saint Paul, Minnesota
www.immunize.org
www.vaccineinformation.org
www.immunize.org/catg.d/p3037F.pdf
Item #P3037F (8/16)
Vaccine Storage Troubleshooting Record
□Refrigerator □Freezer
(check one)
Page 3 of 3
Use this form to document any unacceptable vaccine storage event, such as exposure of refrigerated vaccines to temperatures that are outside the manufacturers' recommended storage ranges.
A fillable troubleshooting record (i.e., editable PDF) can also be found at www.immunize.org/clinic/storage-handling.asp.
Date & Time of Event
Storage Unit Temperature
Room Temperature
Person Completing Report
If multiple, related events occurred,
at the time the problem was discovered
at the time the problem was discovered
see Description of Event below.
Date:
Temp when discovered:
Temp when discovered:
Name:
Time:
Minimum temp:
Maximum temp:
Comment (optional):
Title:
Date:
Description of Event
(If multiple, related events occurred, list each date, time, and length of time out of storage.)
• General description (i.e., what happened?)
• Estimated length of time between event and last documented reading of storage temperature in acceptable range (36
o
to 46
o
F [2
o
to 8
o
C] for refrigerator; -58º to 5ºF [-50
o
to -15
o
C] for freezer)
• Inventory of affected vaccines, including (1) lot #s and (2) whether purchased with public (for example, VFC) or private funds (Use separate sheet if needed, but maintain the inventory with this troubleshooting record.)
• 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.
Action Taken
(Document thoroughly. This information is critical to determining whether the vaccine might still be viable!)
• When were the affected vaccines placed in proper storage conditions? (Note: Do not discard the vaccine. Store exposed vaccine in proper conditions and label it “do not use” until after you can discuss with your state/
local health department and/or the manufacturer[s].)
• Who was contacted regarding the incident? (For example, supervisor, state/local health department, manufacturer—list all.)
• IMPORTANT: What did you do to prevent a similar problem from occurring in the future?
Results
• What happened to the vaccine? Was it able to be used? If not, was it returned to the distributor? (Note: For public-purchase vaccine, follow your state/local health department instructions for vaccine disposition.)
distributed by the
Technical content reviewed by the Centers for Disease Control and Prevention
Immunization Action Coalition
651 - 647 - 9009
Saint Paul, Minnesota
www.immunize.org
www.vaccineinformation.org
www.immunize.org/catg.d/p3041.pdf • Item #P3041 (8
16)
/
Vaccine Storage Troubleshooting Record
□Refrigerator □Freezer
(check one)
Use this form to document any unacceptable vaccine storage event, such as exposure of refrigerated vaccines to temperatures that are outside the manufacturers' recommended storage ranges.
A fillable troubleshooting record (i.e., editable pdf) can also be found at www.immunize.org/clinic/storage-handling.asp
Date & Time of Event
Storage Unit Temperature
Room Temperature
Person Completing Report
If multiple, related events occurred,
at the time the problem was discovered
at the time the problem was discovered
see Description of Event below.
Date: (see below)
Temp when discovered: 45ºF
Temp when discovered: 77ºF
Name: Nancy Nurse
Time: (see below)
Minimum temp: 38ºF
Maximum temp: 53ºF
Title: VFC Coordinator
Date: 6/24/13
temp is approx
Comment (optional):
Description of Event
(If multiple, related events occurred, list each date, time, and length of time out of storage.)
• General description (i.e., what happened?)
• Estimated length of time between event & last documented reading of storage temperature in acceptable range (36
o
to 46
o
F [2
o
to 8
o
C] for refrigerator; -58º to 5ºF [-50
o
to -15
o
C] for freezer)
• Inventory of affected vaccines, including (1) lot #s and (2) whether purchased with public (for example, VFC) or private funds (Use separate sheet if needed, but maintain the inventory with this troubleshooting record)
• 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.
At 8 am on Monday (6/24/13) morning when clinic opened , identified 4 temperature excursions over the weekend in refrigerator with readings
as high as 54°, 50°, 49° & 53°F in primary vaccine storage unit #1. Recordings taken every 15 min on calibrated digital data logger overnight.
Data logger probe in glycol located in middle of refrigerator with vaccines.
Total time out of range: approximately 3 hrs — maximum temp 53°F (see attached document of continuous temp readings)
Inventory of vaccines: see attached
Water bottles in refrigerator door. No vaccine stored in freezer. No problems with storage unit prior to Saturday night. Thunderstorms in area over
weekend may have affected power.
Action Taken
(Document thoroughly. This information is critical to determining whether the vaccine might still be viable!)
• When were the affected vaccines placed in proper storage conditions? (Note: Do not discard the vaccine. Store exposed vaccine in proper conditions and label it “do not use” until after you can discuss with your
state/local health department and/or the manufacturer[s].)
• Who was contacted regarding the incident? (For example, supervisor, state/local health department, manufacturer—list all.)
• IMPORTANT: What did you do to prevent a similar problem from occurring in the future?
Vaccines currently stored appropriately at 40ºF. Refrigerator and vaccines labeled "Do Not Use ."
My State Immunization Program contacted at 8:30 am. Spoke with Victor Vaccine . Provided Victor with details of event and list of vaccines.
Vaccine to remain quarantined until we hear back from Victor.
Called electric company and confirmed 2 short power outages during weekend .
Checked refrigerator seals  called refrigerator maintenance company to replace seals.
Checked plug on unit  placed tape over plug to prevent inadvertent dislodging. Plan to purchase plug guard .
Plan to follow up with Immunization Program on data loggers with alarms that could be sent to coordinator and back-up phones.
Results
• What happened to the vaccine? Was it able to be used? If not, was it returned to the distributor? (Note: For public-purchase vaccine, follow your state/local health department instructions for vaccine disposition.)
Late on Monday, I talked with Victor regarding continued use of vaccine . Victor had checked with manufacturers which confirmed that vaccine is
acceptable for use . He told me that vaccine could therefore be removed from quarantine . I discussed the entire situation with Susie Supervisor and
Dr. Director (clinic medical director) who agreed that we could put vaccine back in use .
distributed by the
Technical content reviewed by the Centers for Disease Control and Prevention
Immunization Action Coalition
651 - 647 - 9009
Saint Paul, Minnesota
www.immunize.org
www.vaccineinformation.org
www.immunize.org/catg.d/p3041.pdf • Item #P3041 (8
16)
/
Vaccine Storage Troubleshooting Record
□Refrigerator □Freezer
(check one)
Use this form to document any unacceptable vaccine storage event, such as exposure of refrigerated vaccines to temperatures that are outside the manufacturers' recommended storage ranges.
A fillable troubleshooting record (i.e., editable pdf) can also be found at www.immunize.org/clinic/storage-handling.asp
Date & Time of Event
Storage Unit Temperature
Room Temperature
Person Completing Report
If multiple, related events occurred,
at the time the problem was discovered
at the time the problem was discovered
see Description of Event below.
Date: 7/16/2013
Temp when discovered: 28ºF
Temp when discovered: 77ºF
Name: Nancy Nurse
Time: 8:00 am
Minimum temp: 28ºF
Maximum temp: 42ºF
Title: VFC Coordinator
Date: 7/15/13
temp is approx
Comment (optional):
Description of Event
(If multiple, related events occurred, list each date, time, and length of time out of storage.)
• General description (i.e., what happened?)
• Estimated length of time between event & last documented reading of storage temperature in acceptable range (36
o
to 46
o
F [2
o
to 8
o
C] for refrigerator; -58º to 5ºF [-50
o
to -15
o
C] for freezer)
• Inventory of affected vaccines, including (1) lot #s and (2) whether purchased with public (for example, VFC) or private funds (Use separate sheet if needed, but maintain the inventory with this troubleshooting record)
• 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 checked main clinic fridge (in lab) at 8:00 am on Tuesday, 7/16/2013, digital readout on data logger read 28ºF. Data logger located in
center of fridge with probe in glycol . Review of computer readings (taken every 15 minutes) showed steady drop in temps from 42ºF at 8:15 pm
(7/15/2013) to 28ºF reading discovered when arrived at clinic on Tuesday morning (7/16/2013). Readings hit 34ºF at 11 pm (7/15) and 32ºF
at 2 am (7/16). Total time out of recommended storage temps = 9 hours, with 6 hours at freezing or below (see attached document of continuous
temp readings). Inventory of vaccines attached .
Water bottles in refrigerator door and crisper area. No vaccines stored in freezer. No recent adjustments to temp controls and no previous temp ex-
cursions noted with this refrigerator before 7/15.
Action Taken
(Document thoroughly. This information is critical to determining whether the vaccine might still be viable!)
• When were the affected vaccines placed in proper storage conditions? (Note: Do not discard the vaccine. Store exposed vaccine in proper conditions and label it “do not use” until after you can discuss with your
state/local health department and/or the manufacturer[s].)
• Who was contacted regarding the incident? (For example, supervisor, state/local health department, manufacturer—list all.)
• IMPORTANT: What did you do to prevent a similar problem from occurring in the future?
Upon discovery, vaccines marked “Do Not Use” and stored in 2nd clinic fridge (in exam room #3 at 41ºF ). Also placed “Do Not Use” note on main
fridge in lab. Notified Susie Supervisor about the issue . Contacted Victor Vaccine at My State Immunization Program at 8:30 am. Provided Victor
with details of event and list of vaccines in fridge . Victor said to maintain vaccines in 2nd fridge and that he would check with manufacturers to
determine next steps.
Called Jim’s Appliance Repair to examine fridge . Repairman found and replaced faulty thermostat in unit.
Reset data logger on center shelf in fridge with probe in glycol .
Results
• What happened to the vaccine? Was it able to be used? If not, was it returned to the distributor? (Note: For public-purchase vaccine, follow your state/local health department instructions for vaccine disposition.)
After fridge thermostat repaired , monitored temps in empty fridge for 1 week , per state requirements. Fridge maintained 38º-40ºF temps for entire
week . Submitted repair documentation and data logger readings to Victor Vaccine for approval and ordered replacement vaccines. Victor had checked
with manufacturers who confirmed that all vaccines in fridge EXCEPT MMR were no longer viable and should be returned per state policy
guidelines. MMR may be used because pkg insert allows storage down to -58ºF. Discussed entire situation with Susie Supervisor and clinic
director, Dr. Director, who agreed on continued use of MMR . Will continue to monitor fridge closely to watch for pattern of temp fluctuations
indicating potential problem with thermostat. If problems, contact Victor Vaccine for advice on purchasing new fridge meeting criteria for
appropriate vaccine storage .
distributed by the
Technical content reviewed by the Centers for Disease Control and Prevention
Immunization Action Coalition
651 - 647 - 9009
Saint Paul, Minnesota
www.immunize.org
www.vaccineinformation.org
www.immunize.org/catg.d/p3041.pdf • Item #P3041 (8
16)
/
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