Non-Viable Vaccine Return and Wastage Form
Provider ID Number:
Complete this form before returning unopened, non-viable vaccine.
Print two copies of the confirmation page, one for your records and one for McKesson
Ship unopened non-viable vaccine and a copy of the confirmation page to McKesson in a shipping container received from previous vaccine shipments.
Open vials, including multi-dose vials, or open pre-filled syringes, cannot be sent to McKesson
. 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.
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
. Send the shipment with a UPS driver.
DO NOT ship viable vaccine to McKesson
DO NOT ship viable or non-viable vaccine to the NDDoH
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)