Non-Viable Vaccine Return and Wastage Form
Provider ID Number:
Complete this form and submit. Please keep a copy of the confirmation page for your records.
Prior to returning unopened, non-viable vaccine, you must have a packing slip from the NDDoH AND a shipping label from McKesson.
Ship unopened, non-viable vaccine and a copy of the packing slip in a shipping container received from previous vaccine shipments.
For vaccine in open vials/syringes, use this form to report the wasted/expired vaccine, and then dispose of it per your facility’s policy. Open vials/syringes must never be returned to McKesson.
Check here to have a McKesson return label sent to you in the mail.
DO NOT contact UPS or McKesson directly to arrange for a pick up.
DO NOT ship viable vaccine to McKesson.
DO NOT ship viable or non-viable vaccine to the NDDoH
DO NOT ship privately-purchased vaccine to McKesson. Only state-supplied vaccine should be returned to McKesson.
Has this return/wastage been entered in NDIIS (THOR) by your facility?
Failure to store properly upon receipt
Natural disaster/Power outage
Refrigerator too cold
Refrigerator too warm
Spoiled - other
Vaccine spoiled in transport
Lost or unaccounted for vaccine
Non vaccine product (e.g., IG, HBIG, diluent)
Open vial but all doses not administered
Vaccine drawn into syringe but not yet administered
Hep A/Hep B
Meningococcal Conjugate (MCV)
Pneumococcal Conjugate (PCV)
Pneumococcal Polysaccharide (PPV)