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Recording and reports on immunisations
Please use this form when ordering any seasonal influenza vaccine and all National Immunisation Program vaccines.
Vaccination recording form
Vaccine providers who do not currently send vaccination records to the NT Immunisation Register electronically please complete this form for people of any age who have received a vaccination.
Fax the form to the NT Immunisation Register on 8922 8897 OR Email: ImmunisationUnit.THS@nt.gov.au
Adverse event following immunisation form
Adverse events following immunisation refer to any untoward medical occurrence that follows immunisation, whether it is expected or unexpected and regardless of whether it is triggered by the vaccine or coincidentally occurs following its administration.
AEFIs can be reported by any health professional, vaccine provider, patient or their families.
Part A of this form should be filled out in as much detail as possible about the vaccines administered and the reaction which occurred. Fax completed forms to the Centre for Disease on (08) 8922 8310.
Please refer to the current Australian Immunisation Handbook for specific definitions and advice on adverse events following immunisation.
Part B of this form should be completed 60 days after the reported reaction and forwarded to Centre for Disease Control Darwin on fax (08) 8922 8310.
Call your local Centre for Disease Control for any further advice.
Download the Adverse event following immunisation form.
BCG incident and side effects reporting form
This form should be used to report both incidents relating to administration as well as BCG side effects. An Adverse Event Following Immunisation form (AEFI) should also be completed. Fax both forms to the Centre for Disease Control Darwin on (08) 8922 8310.
Cold chain graph
Keep all vaccines between 2-8°C. Strive for 5°C.
Check and record the vaccine refrigerator temperature (minimum and maximum) twice daily; before the refrigerator is used for the first time and at the end of each day.
Centre for Disease Control (CDC) has changed the biannual usage/wastage reports. Vaccine usage will no longer be collected and wastage will be reported throughout the year rather than biannually.
Please complete the attached form to record all vaccine wastage from your clinic at the time the vaccine is discarded. Vaccine providers are only required to complete this form when wastage occurs. Vaccine providers should still continue to report any cold chain breaches prior to discarding vaccines by calling CDC.
Fax all forms back to Centre for Disease Control Darwin on (08) 8922 8310.
Lyssavirus post-exposure prophylaxis recording form
Please contact Centre for Disease Control if you have a patient with a potential exposure to lyssavirus or rabies.
Post-exposure vaccination can be provided by Centre for Disease Control during regular working hours and NT public hospital Emergency departments after hours.