68%

IACUC Protocol # (If Known):
PI or Personnel involved in the Adverse Event (if applicable):
Date the Event Occurred:
Location Event Occurred (area, building, room, etc):
Is the possibility that this type of event could occur noted in the protocol?
Is the possibility that this type of event could occur noted in the protocol?
Does this event exceed the noted level of such an event (i.e. 10% mortality expected but experienced 15%)?
Does this event exceed the noted level of such an event (i.e. 10% mortality expected but experienced 15%)?
Provide a description (include dates and details of the adverse/unanticipated problem):
Has this type of event been previously reported on this study or associated with this PI?
Has this type of event been previously reported on this study or associated with this PI?
In your judgement, is a change in procedure or handling methodology necessary to reduce or eliminate future reoccurrence of this type of adverse event/unanticipated problem?
In your judgement, is a change in procedure or handling methodology necessary to reduce or eliminate future reoccurrence of this type of adverse event/unanticipated problem?
Provide a complete description of how this event/problem was managed, including all personnel alerted and dates of contact (if known):
Provide a complete description of the corrective actions taken to ensure that this type of event/problem does not occur in the future (if known):
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