Report an Adverse Event | Institutional Animal Care and Use Committee

Principal Investigators affiliated with the University of Tennessee, Knoxville may use this form to report an adverse event to IACUC and OLAC.

If something unfavorable (morbidity or mortality) happens to one or more study animals that was not anticipated, OLAC should be contacted immediately to address any animal welfare concerns.

"*" indicates required fields

Name

First Last

Phone

IACUC Protocol Number*

If you are unaware of protocol number please put NA

Describe the adverse event; include number of animals affected and the total numbers of animals undergoing the study associated with the adverse event up to this point (this is not necessarily the approved number of animals, since all animals may not be enrolled in the study yet).

Provide a brief description of the study in a time line. Include in this time line all information (administration of agents {including route, volume and frequency}, procedures performed) pertaining to the adverse event.

Indicate steps taken following adverse event– treatment given, animal euthanized, necropsies performed/by whom, evaluation of surviving animals, re-evaluation of the study group affected to determine potential causes for the adverse event.

Definite or proposed cause for adverse event.

Proposed plan for future animals related to the above findings.

Phone

This field is for validation purposes and should be left unchanged.

The adverse event will be discussed at the next IACUC meeting. The committee may request additional information or request an amendment be submitted to account for any proposed changes.