VACCINATION QUESTIONNAIRE Please mail to : S.T.A.R.* Ferrets, c/o Pam Grant, 7402 Joseph Court, <RETURN>, <S>croll, <Q>uit ?s Annandale, VA 22003 Due to the recent controversy concerning canine distemper vaccines, their uses and their results, S.T.A.R.* Ferrets and the ACME Ferret Company have decided to go on a fact finding mission. We are interested in finding out which vaccines are being used for ferrets, how they are being administered, by whom, and the results. If you vaccinate your own animals and wish to remain anonymous, please just fill in the city and state where you live. If you or your veterinarian have any more information to provide, please feel free to write details. 1. What vaccine are you using to protect ferrets against canine distemper? FERVAC - D, FROMM -D, OTHER: 2. Who is administering the shot? SELF, VET, OTHER: 3. Where is the ferret being injected? NECK AREA, SHOULDER AREA, HIP AREA, RUMP AREA, ARM AREA, LEG AREA, OTHER: 4. Is the vaccine warmed to room temperature before being injected? YES NO 5. What gage needle is being used? 22, 25, OTHER: 6. What length needle is being used? 3/4", 1", OTHER: 7. Are you using the sterile solution which is packaged with the vaccine? YES NO 8. Have you ever used any other canine distemper vaccine? YES NO If so, which one(s): FERVAC - D, FROMM -D, OTHER: 9. Are you having any reactions with your present canine distemper vaccine? YES NO 10. Have you had any reactions with your past canine distemper vaccine? YES NO 11. Please list any reactions & % below for PRESENT Vaccine & PAST Vaccine a. no reactions b. stings ferret while injecting vaccine c. ferret screams while injecting vaccine d. ferret becomes lethargic after vaccination e. vomiting occurs after vaccination f. seizures occur after vaccination g. other problems: h. lot number & date on the vaccines: i. was this shot given in conjuction w/rabies: j. month/year of vaccination(s): k. how many vaccines have you used/year: Name:______________________________________________ City:______________________________________________ State:_____________________________________________ Signature:_________________________________________ Date:______________________________________________ [Posted in FML issue 0444]