ࡱ> molM bjbjd&d& 4"LGiLGi!<...8f,$.1t%^E&a&=1?1?1?1?1?1?1$235c1*1#%**c1e x1.,.,.,*v&=1.,*=1.,.,/DM/0Ͽ> x*/)1101!/,6+L6M/6M/q&'h.,k'T'Cq&q&q&c1c1R+q&q&q&1****6q&q&q&q&q&q&q&q&q&X : INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE ADVERSE EVENT FORM Adverse Event: Any happening not consistent with routine expected outcomes that results in any unexpected animal welfare issues (death, disease, or distress) or human health risks (zoonotic diseases or injuries). Both the PHS Policy (IV.C.5.) and USDA Animal Welfare Regulations (9CFR 2.3.d.5) require continued review of previously approved projects. The IACUC, as part of post approval monitoring, encourages investigators to submit an adverse event form for any unexpected injuries to animals during the course of the project. All materials must be typed and submitted to the Research Ethics Review Coordinator, Grants, Research & Sponsored Programs, DDH D-108, ֱ, Bakersfield, 9001 Stockdale Highway, Bakersfield, California 93311. Send an e-mail to  HYPERLINK "mailto:org-rerc@csub.edu" rerc@csub.edu or call (661) 654-2381. Principal Investigator: Email: Department: Telephone: Project Title: IACUC Proposal No. 1. Event Date:  2. Severity of Event: Moderate Severe Fatal 3. Is this event related to the research or educational activity covered by the protocol?  Related Possibly Related Not Related 4. Description of event (include location). 5. Cause of event. 6. Outcome of event. CHANGES NECESSITATED BY ADVERSE EVENT/INJURY In your opinion, does this adverse event/injury require a change in the protocol? Yes No If yes, please attach a proposed protocol modification.  Review of adverse event (date and description):   This adverse event report filed with protocol no further action required  Reported to IACUC for review and action This report filed at end of authorization period with no adverse events to report. 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