Annual Immunocontraception Data Sheet - The Science and Conservation Center

Zoo Information

Zoological Garden *

Animal Information

Species *

ID/ISIS *

Birth Date *

Weight (KG) *

Previous Reproductive History

Date of Birth

Note

Date of Birth

Note

Date of Birth

Note

Date of Birth

Note

Date of Birth

Note

Inoculation History

Inoculation 1

Inoculation Date

PZP Dose (µg) / lot #

The standard dose is 100µg unless you were otherwise notified.

Adjuvant

FIA

MFA

Means of Administration

Injection Site

Where the injection was administered, either right or left

Inoculation 2

Inoculation Date

PZP Dose (µg) / lot #

Adjuvant

FIA

MFA

Means of Administration

Injection Site

Inoculation 3

Inoculation Date

PZP Dose (µg) / lot #

Adjuvant

FIA

MFA

Means of Administration

Injection Site

Inoculation 4

Inoculation Date

PZP Dose (µg) / lot #

Adjuvant

FIA

MFA

Means of Administration

Injection Site

Inoculation 5

Inoculation Date

PZP Dose (µg) / lot #

Adjuvant

FIA

MFA

Means of Administration

Injection Site

Concurrent Drug Use

Any other Pharmaceuticals used during the course of study

Drug Name

Dose

Dates of Administration

Drug Name

Dose

Dates of Administration

Drug Name

Dose

Dates of Administration

Post Inoculation Reproductive History

If any offspring were born, describe their general health.

Date of Birth

Note

Date of Birth

Note

Date of Birth

Note

Date of Birth

Note

Date of Birth

Note

Post-Treatment Behavioral/Clinical Signs of Estrus

Date

Note

Date

Note

Date

Note

Date

Note

Date

Note

Problems

Describe Any Pre-Treatment Health Problems

Describe Any Post-Treatment Health Problems

Describe Any Unusual or Unexpected Post-Treatment Behavioral Displays or Problems

Males

Describe any dates when male was removed, separated and/or introduced. If any offspring were born, describe their general health.

Date

Note

Date

Note

Date

Note

Date

Note

Date

Note

PZP Treatment Discontinues

If PZP Treatment Is Discontinued Please State Reason Including Planned Reversal

Additional Information

Additional Remarks

Note: If any treated animal is transferred to another zoo, please note location on Data Sheet

Verification

Verification *

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