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Collected by all P/Ts. Return completed form to your Regional Medical Officer of Health (MOH). See attached list with contact information. Reporting form: Report of Adverse Events Following Immunization (AEFI). Developed by the Public Health Agency of Canada and adapted with permission by Manitoba Health. PHAC 08/2011 2 Initial report Follow up report Reporting form for Adverse Events Following Immunization (AEFI) 1a) Unique episode number: (Unique episode number) 1b) Region number: 2).

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