The URL can be used to link to this page

Home My WebLink AboutRabies - 2003REQUEST FOR RABIES E%AMINATION State Laboratory Institute, Virology Division Rabies Laboratory; (617) 522-3700, x194/196 SUBMITIER�tCi Agency Street taa,r ry �k City/State/Zip 31lU�.4. Phone (6bi ) -i_3 —oj2? Owner or Person Who Found Animal Street City/State/Zip Phone ( ) u.ruicuvla11v1V (use reverse side for additional information) ANIMAL SPECIES: Breed `SlA_ Age �t ❑Stray ❑Wild ❑Unknown Why is animal to be tested? Human exposure ❑ Pet exposure ❑ Acting sick Symptoms: Cr3�ggression ❑ Ataxia ❑ Disorientation ❑ Lethargy ❑ Paralysis ❑ Salivation ❑ Seizures ❑Unexplained wo�u d ❑found dead ❑ Other f+ed as iChcIL t i pti�� }lwh Cause of death: ErNatural ad Method e oCLU Vaccinated for rabies: ❑ Yes 9No ❑Unknown Date of vaccination Datf death Travel out of stale: ❑ Yes ❑ No nknown Where-- When Bitten by another animal within 12 months: Yes ❑ No nknom U wn if yes, by what? In what TOWN was animal fo,�nd? _YLSQ�ct In what C0� UoN,�7 EXPOSURE INFORMATION (use reverse side for additional information) PERSON(S)_ EXEQSED: Name JIVE I SLca Street _ 9i� min.\r n S-� City/State/Zip Phone (6iyj Type oi posure: E Site p Scratch ❑ Lick ❑ Unknown ❑ Other _ Date of exposure 'i 03 Body site f1 A Ayj Severity of exposure Circumstance of exposures�':' ❑ Capture ErHandling ❑ Specimen prep. ❑ Unprovoked attack ❑ Provoked attack • Indirect exposure ❑ Other Was person previouw�vaccinated? ❑ Yes' o ❑ Unknown Did person receive rabies S 066 after incident? ❑ Yes ❑ No ErUnknown Physician/Hospital Phone ANIMAL(S) EXPOSED: Name Species Owner Street City/State/Zip Phone ( ) Type of exposure: ❑ Bite ❑ Scratch ❑ Lick ❑ Unknown ❑ Other Date of exposure Circumstances of exposure: ❑ Fight ❑ Vicinity ❑ Dead animal contact ❑ Other Was animal's rabies vaccination up-to-date? ❑ Yes ❑ No ❑ Unknown Did animal receive rabies booster after incident? ❑ Yes ❑ No ❑ Unknown REQUEST FOR RABIES E<YAtVE NATION State Laboratory Institute, Virology Division Rabies Laboratory (617) 983-6385, -6387 FOR LAS-USE::ONLY Date: Received: 0 (-/CI-03 Lab No::, SUBiMITTER id ✓ ��o,U��/e �/ AgencyOwner or Person Who. Found Animal o,.i/.tc• �fiG�. Street Street _- s2 City/State/Zip %r�/As��`/v? �/� G2�Y� / zr-CitylState/Zip /y/vr ✓/� , �/� c>z� y -i z <— _ Phone( vy)_ZG/-7?oo Phones-) SPECIMEN INFORMATION (use reverse side for additional information) ANIMAL SPECIES: Breed L`/ Age ? ❑ Pet )ZStray ❑ Wild VUnknown 'Why is animal to be tested? ❑ Human exposure XPet exposure ❑ Acting sick Symptoms: ❑ Aggression ❑ Ataxia ❑ Oisorfentation ❑ Lethargy ❑ Paralysis 0 Salivation 0 Seizures ,KUnexplained wound 0 Found dead 0 Other Cause of death: ❑Natural Killed Method 06XJ' Date of death / _? v3 Vaccinated for rabies: ❑ Yes ❑ No 0 Unknown Dale of vaccination . Travel out of state: ❑ Yes ❑ No 19Unknown Where When Bitten by another animal within 12 months: ❑ Yes ❑ No ,Unknown If yes, by what? In what TDM was animal found? r? In what S�OUN ? EXPOS'3I2E INFORMATION (use reverse side for additional information) PERSON(S) EXPOSED: Name Street City/State/Zlp Phone ( ) Type of exposure: ❑ Bite 0 Scratch ❑ Lick ❑ Unknown 0 Other Date of exposure -Body-site —__--- - --_ - Severity of exposure Circumstance of exposure:, ❑ Capture ❑ Handling ❑ Specimen prep. ❑ Unprovoked attack ❑ Provoked attack ❑ Indirect exposure ❑ Other Was person previously vaccinated? ❑ Yes ❑ No ❑ Unknown Did person receive rabies shots after incident? ❑ Yes ❑ No 0 Unknown Physician/Hospital Phone ANIMALS) EXPOSED: Name /l Species C,"vi�R/cs Owner ltreel S g uJ, r y n v City/State/Zip Deere Phone(jby) 9 — 2jO7o Type of exposure: 08ite I'Scratch ❑ Lick ❑ Unknown -Other - Date of exposure ///s A S Circumstances of exposure: OkPight ❑ Vicinity ❑ Dead an contact ❑ Other Was animal's rabies vaccination up-to-date? M Yes ❑ No 0 Unknown Did animal receive rabies booster after incident? ❑ Yes 0 No ❑ Unknown LABORATORY RESULTS' -• FLUORESCENT RABIES?ANTI800Y'TES.T Test Date I I POSITIVE:(RA810) Q NEGATIVE: (NOT RABID). LSPECIMEN UNSATISFACTORY ❑ COMMENTS. Y REQUEST FOR RABIES ATION EXANUN FOFi 4i�B Star 1 abotbtory Instigtte, Virology Divialoa bete'fieceivedt Rabies laboratory (617) 983 6385, 6386, 6387Jt SUBMITTER A Agency Owner or Person Who Found Animal P Street U7"9S wcs� P1Jn�i S street_ ia(t(o Ea34 S� C47SIsWZ;p 023 iq cltytstale/Zip f YYYzn c F^Y i Phone (Sc2) F — 2 I > 7 -wt 0� 20 7 Phone (S68) _ 33 �1— Coto f3 c>t SPECIMEN INFORMATION (use reverae aide for additional Information) ANIMAL SPECIES: 4ji rna, Breed DG 4 Age --4� Kpet ❑ Stray ❑ Wild ❑ Unknown Why Is animal to be tested? KHuman exposure ❑ Pei exposure ❑ Acting sick Symptoms: ❑ Aggreaalon ❑ Ataxia ❑ Dsorfentalbn ❑ Lethargy ❑ Paralysis ❑ Salivation ❑ Seizures Unexplained wound ❑ Found dead ❑ Other Cause of death: ❑ Natural Willed Method_ E0fi)e e o 1 Date of death 1- I te- 03 Vaccinated for rabies; []Yes ❑ Nocirk,P Unknown Date of vaccination Z - I Z - C7 Fr (£xpi rec( Travel out of stale: ❑ Yes ❑ No ❑ Unknown Where When Bitten by another animal within 12 months: ❑ Yes ❑ No Unknown If yes, by what? In what TOWN was animal "? 15 ona'Isp , { of In what CO=? EXPOSURE R FORr ATIKON (use reverse side for additional information) PERSONS) EXPOSED: ANIMAL(S) EXPOSED: Name Pitt7la Deal" Name Street Izy(n ierqj, Sj city/slate/zip-E.np �' Spaces Yj2_ r.. /n�3 !'YI/=1 Rio 3 J Owner Phone (Sos ) 339 - (n( 4 �l Street Typo of exposu city/Slale/Zp ❑ Bite kcralct ❑ Lick ❑ Unknown Phone ( ) ❑ Other Dale of expo Type of exposure: re _1— /(� - (j Body site ❑ Bile ❑ Scratch ❑ Lick ❑ Unknown ��) IQ Severity of exposO Other --rn1� Dale of exposure Circumstance of exposure: Circumstances of exposure: ACap(ure ❑ Handling ❑ Spedmen prep. ❑ Fight ❑ Vicinity ❑ Dead animal contact ❑ Unprovoked attack ❑ Provoked attack ❑ Other ❑ Indirect exposure ❑ Other Was animal's rabies vaccination up -to -dale? Was person previously vaccinated? ❑ Yes ❑ No ❑ Unknown ❑ Yes No ❑Unknown Did animal receive tables booster after Incident? Did person receive rabies shots after Incident? ❑ Yea ❑ No ❑ Unknown r ❑ Yes ❑ No Qonknown Physician/Hospital Phone L LABORATORY RESULTS = FLUdRESCENTRABIES:ANTIBODY TEST Taet:Dat® I )� u POSITIVE (RABID).❑ NEGATIVE (NOTRikely SPECIMEN UNSATISFACTORY ❑ e COMMENTS: N(_ . L Y REQUEST FOR RABIES E.YANM CATION FOR LAE:USE::ONLY�/ State Laboratory Institute, Virology Division Date: Received: `t —�� Rabies Laboratory (617) 983-6385, -6387 - Lab-No::05 G(p SUBMITTER 'e. Co1/1�! Agency _� c U ��' /LI,r✓SF,�r/ Owner or Person Who Found Animal Street 3b ficJrrsi s% •• Street !f 6crd_✓71t City/Slate2ip i�i21!sr"r , /x Cr • c%r City/State/Zip /Mrvs�+J7cP y� aZ�yd Phone (mod) _ zG /- '36o Phone (Sti&) 33 5 — b 9r16 SPECIMEN INFORMATION (use reverse side for additional information) ANIMAL SPECIES: Cc wv Breed Age ) Vt ❑ Pet ❑ Stra Y FWild 0 Unknown Why is animal to be tested? ❑Human exposure Vet exposure Acting sick Symptoms: gAggression ❑ Ataxia 4 Olsodentation ❑ Lethargy ❑ Paralysis ❑ Salivation ❑ Seizures ❑ Unexplained wound ❑ Found dead ❑ Other Cause of death: ❑ Natural Killed Method S'6fo7 Date of death r/ ar 7113 Vaccinated for rabies: ❑ Yes ❑ No Unknown Date of vaccination Travel out of state: ❑ Yes ❑ No X Unknown Where When Bitten by another animal within 12 months: ❑ Yes ❑ No 0�tnknown If yes, by what? In what TOWN was animal found? Inwhat GQUlLTY? lgir.rra/ PERSON(S) EXPOSED: Name Street City/Slate/Zp Phone ( ) Type of exposure: ❑ Bite ❑Scratch ❑ Other Date of exposure Body site INFORMATION (use reverse side for additional information) ❑ Lick ❑ Unknown ,�eventy of exposure Circumstance of exposure: ❑ Capture ❑ Handling ' ❑ Specimen prep. ❑ Unprovoked attack ❑ Provoked attack ❑ Indirect exposure ❑ Other Was person previously vaccinated? ❑ Yes ❑ No ❑ Unknown Did person receive rabies shots after incident? ❑ Yes ❑ No ❑ Unknown Physician/Hospital Phone ANIMAL(S) EXPOSED: Name klC o t/fn_ Species 6,g,v,:V�6r Owner 7o-�/ld ,yf�7 /onl 4reet V Gc dNy nce Cinc/J City/State/Zip dyk Phone(rOV) 312— 4496 Type of exposure: ❑ Bite ❑ Scratch X Other �N%a Date of exposure Circumstances of exposure: ❑ Fight KVicinity ❑ Other t7 Lick KUnknown ❑ Dead animal contact Was animal's rabies vaccination up-to-date? A4 Yes ❑ No ❑ Unknown Did animal receive rabies booster after incident? ❑ Yes ANo ❑ Unknown u LABORATORY RESULTS - PLUORE.SCENT RABIE.S:ANTI800Y TEST Test Date A u POSlTIVE:(RA81D) l �%� NEGATIVE (NOT RABID) El. SPECIMEN UNSATISFACTORY ❑ s c / ,jj e COMMENTS: f ✓��G'r't/ rv� �CaNr,O ,J c J v t� C,1,4 / -66 � Y 01 : The CoMmonwealth bf Massachusetts • - ' Executive, Office•of HeNth.and Human Services bepartrrient,of Public Health 250 Washington.Si' et, Boston; MA 021.08-4610: ' '•MITT ROMNEY- .. y� GOVERNOR, ':. . r ... 4 ;i pp • ORRYHEALEY Jri LIEUTENANT GOVERNOR .. RONALD PRESTON ".', .," y • '' ' }r . secRETARv Rabies Laboratory, "'ext.' 6385 •- •CHRSSTINE G., FERGUSON '"...GOMMISSONER ... .. 04/23/20,03,. -.,, '.. I .... - . Attn,:'Mansfield Board of Health -Iaat"ulnber:-RA03 GG-6b6 'Animal—.RaC Qoi ...,.-_.Found-ir�Mans-f Submitted by: Mansfield Ariimaj Control'-', _Mansf•'ield S.08' 2.61-7300 I , ITest'Date: 04/23/200,3' .' 'gesult: POSITIVE I .•. - .: ,. Exposi}re,inform atian:' IAn�ifmai exposute ` $ ' J..''Dog; '; Jackie_Honnori .(owner) Mansfield ' S08-339-6976 Comntelits 'If• you ",,Are aware of any additional expodUres, of havf, any corrections to this. report,'.please.call the above number'.'' r 04/25/2003 FRI 10:45 FAX 508 261 7425 TOWN OF MANSFIELD [a001 N: N: N: N: N: N: N; N: N: N: N: N: N: N: N: N: N: N: W N: •k. TX REPORT TRANSMISSION OK TX/RX NO 1070 DEPT. ID 3652 CONNECTION TEL 915083391031 SUB -ADDRESS CONNECTION ID ST. TIME 04/25 10:43 USAGE T 01'16 PGS. 2 RESULT OK TOWN OF MANSFIELD, MASSACHUSETTS Six Park Row, Mansfield, MA 02048 FAX COVER SHEET TOWN OF MANSFIELD BOARD OF HEALTH Date: 4 5 03 Time: From: Town of Mansfield Phone: 508-261-7366 Board of Health Fax: 508-261-7343 Six Park Row Mansfield, MA f 02048 To: C6 Type of Form No of pages: M (Incl. cover sheet) ess�a`ge�. u 8 E REQUEST FOR RABIES EXANJINATION �D•� LAt3 USE ONLY State Laboratory Institute, Virology Division :'beta RnCe�vetl; /� Rabies Laboratory (617) 983 6385, 6386, 6387 Lab'Na. g03�� SUBMITTER T).0 YKnrv,n Agency Alai � - nn}, .r,kto S} r^ iJe�erorPerson Wile Found Animal Street 59( �d °(' Cffo/Slat P Slroi _)\ti ni\ Phone(:OY) n�a } 'City/Stale/ZipT "n 01)�0r4n1 rfy(a '(1 �4-1/anl'�/(sn�_ kn ?ter phone ilnarl- SPECIMEN INFORMATION. (use reverse side for addhbnal Information) ANIMAL SPECIES: _Jej; n p Breed Age c5 jg'Pel ❑ Stray O Wild ❑Unknown Why Is animal to be tested? kHuman exposure ❑pet e�oaure ❑ Acing sick Symptoms: D Aggression ❑ Ataxia ❑ Disorientation ❑ Lethargy ❑ Paralysis ❑ Salivation ❑ Seizures O Unexplained wound ❑ Found dead 'Other hid okC4 t�cr k ncl V(LCC i i� Cause of death: ❑ Natural Willed Method Vacdnated for rabies: ❑ Yes Data of death a is �No f7 Unknown Data of vaccination Travel out of state: ❑ Yea D No )KUnknown Where Bitten by another animal within 12 months: ❑ Yes ❑ No When In what )In Unknown If yes, by what? 79WN was animal (Q{ip)j7 •fY1.r� •n 4,�i r\ A In what COUNTY? EXPOSURE INFORMATION lure reverse side for additional information) FE RSON(S) EXPOSED: Name FiiZn "14� In�nr a\� Street 19(a (ImAiJobora Im City/S(ate/Zrfzr Phone(5p)fo Type of exposure: ,XBite ❑ Scratch ❑ Lick ❑ Unknown ❑ Other Date of exposure i p Body site Severity of exposure Circumstance o% exposure: EI Capture Wandling ❑ Spedman prep. ❑ Unprovoked attack ❑ Provoked attack ❑ Indirect exposure ❑ Other Was person previously vaccinated? 'Yes O No O Unknown Did person race" rabies shots after Incident? ❑ Yes ❑ No O-Unknown Physician/Hospital Phone ANIMAL(S) EXPOSED: Name Species Owner Sheet Cily/Slateop Phone ( ) Type of exposure: ❑ Bile ❑ Scratch in • 11 ❑ Lick O Unknown Date of exposure Circumstances of exposure: ❑ Fight CI Vicinity ❑ Dead animal contact ❑ Other Was animal's rabies vaccination up-to-date? ❑ Yes t] No d Unknown Did animal receive rabies booster after Incident? ❑ Yea O No O Unknown LABORATORY RESULTS FLU ORESCENTRABIE3:ANTIBODY TEST TeatDate � Cr //� 2 POSITIVE (RABID) ❑ NEGATTI/E (NOT:RAMD):/)q SPECIMEN UNSATISFACTORY ❑ COMMENTS: �l I�.. - �. PAA- C -- I NORWOOD ANIMAL HOSPITAL 437 WALPOLE STREET NORWOOD, MASSACHUSETTS 02062 (781) 769-3011 TO: &aMlo( DEPARTMENT OF PUBLIC HEALTH Y_- FROM: NORWOOD ANIMAL HOSPITAL -- - DATE: //2// SUBJECT: REPORT OF POTENTIAL RABIES EXPOSURE THE FOLLOWING ANIMAL WAS PRESENTED TO OUR HOSPITAL WITH A BITE WOUND OF UNKNOWN ORIGIN. WE HAVE NOTIFIED THE OWNER OF THE PROPER PROCEDURES AND WILL NOTIFY THE ANIMAL INSPECTOR. THIS ANIMAL (IS_AZ ) (IS NOT ) CURRENTLY VACCINATED. DATE OF LAST RABIES VACCINATION .-)-()� Date....: 6/07/03 Owner ... :Beverly Gaal 25 Longwood Circle Mansfield, Ma. 02048 Phone ... :(508) 261-2990 Animal..:Mulder Age ..... :03 Yrs 10 Mths Weight..: 5 lb 4 oz Breed ... :DOM.LONG HAIR Color ... :BLACK/WHITE Species.:FELINE Sex ..... :NEUTERED MALE SINCERELY, NORWOOD ANIMAL HOSPITAL 06/09/2003 MON 10:30 FAX 508 261 7425 TOWN OF MANSFIELD 0001 TX REPORT i:8: 4 g 8::K TRANSAIISSI0N OR TX/RX NO 1138 DEPT. ID 3652 CONNECTION TEL 915083391031 SUB -ADDRESS CONNECTION Ill ST. TIME 06/09 10:29 USAGE T 01'14 PGS. 2 RESULT OK TOWN OF MANSFIELD, MASSACHUSETTS Six Park Row, Mansfield, MA 02048 FAX COVER SHEET TOWN OF MANSFIELD 13OARD OF HEALTH Date:_(„ - i - 0 Time: From: Town of Mansfield Phone: 508-261-7366 Board of Health Fax: ' 508-261-7343 Six park Row Mansfield, MA 02048 To: - I I Ls - Type of Form No of pages: D- Message: (Incl. cover sheet) REQUEST FOR RABIES EXAIVfINATION State Laboratory Institute, Virology Division Rabies Laboratory (617) 983-6385, -6387 F.OR'tA&USE::ONLY! Date". Received: Lab.. No-.. Mn SUBtY1ITTE�R/ Agency Owner or Person Who Found Animal Street f U Street /C> Cdrsi v«'i si. City/State/Zip o z a ye Cily/Slate/Zip Phone (5&) z 6 /-- -2 30 SPECIMEN INFORMATION (use reverse side for additional information) ANIMAL SPECIES: ('Ir,, .A,- Breed Age —� % ❑ Pet ❑ Stray k/ild ❑ Unknown Why is animal to be tested? ❑ Human exposure KPet exposure ❑ Acting sick Symptoms: ❑ Aggression ❑ Ataxia ❑ Disorientation ❑ Lethargy ❑ Paralysis ❑ Salivation ❑ Seizures ❑ Unexplained wound ❑ Found dead 0Other dos Cause of death: ❑ Natural g Killed Method &C, . f71—,c /h ' Date of death Vaccinated for rabies: ❑ Yes ❑ No 41-Inknown Date of vaccination . Travel out of state: ❑ Yes ❑ No gUnknown Where When Bitten by another animal within 12 months: ❑ Yes ❑ No Unknown If yes, by what? In what TOWN was animal faan_d? 114a�rs,-�r/ In what COUNTY? 1//// EXPOSURE INFORMATION luse reverse side for additional information) PERSON(S) EXPOSED: Name 0 N Y S treet City/State/Zp Phone ( ) Type of exposure: ❑ site ❑Scratch ❑ Lick ❑ Unknown ❑ Other Dale of exposure Body site Severity of exposure Circumstance of exposure: ❑ Capture ❑ Handling ' ❑ Specimen prep. ❑ Unprovoked attack ❑ Provoked attack ❑ Indirect exposure ❑ Other Was person previously vaccinated? ❑ Yes ❑ No ❑ Unknown Old person receive rabies shots after incident? ❑ Yes ❑ No ❑ Unknown P hysician/Ho sp i tal Phone ANIMAL(S) EXPOSED: Name 7Lx ai L4.s Species Go-r�°i;✓ Owner /uo. Ck� f o L, /1C7 0 et street 16 C d, r u i" S,. City/State/Zip /�2 a 'z d YJ' Phone (Sog) ?a 9 -. Type of exposure: ❑ Bite ❑ Scratch ❑ Lick ❑ Unknown Pother 1)0& �^.GTrFk,149 Date of exposure /!7/n 7 Circumstances of exposure: )!`Fight ❑ Vicinity ❑ Dead animal contact ❑ Other Was animal's rabies vaccination up -to -dale? Dyes ❑ No ❑ Unknown Did animal receive rabies booster after incident? ❑ Yes -]'No ¢*Unknown LABORATORY RESULTS'- FLUORESCENT RABIES :ANTIBODY 'TEST Test Date POSITIVE: (RABID) ❑ NEGATIVE(NOT RABID) .❑:ff y SPECIMEN UNSATISFACTORY)Wy COMMENTS: /` S�a ° «wwit 0 t l�l^t t2iCk.� REQUEST FOR RABIES E<YAly NATION State Laboratory Institute, Virology Division Rabies Laboratory (6l7) 983-6385, -6387 FOR LAfi<USE:.ONLY Dam Received: Lab:.No::: F,903 ISM SUBtitITTER�//�r�r/� /� Agency /7UrY ArJ � o��,,cc a-� Owner or Person Who Found Animal X"-I-� , 0_4 Street Street (a -T�T— CityiSlale(Lip it�mr��/Cf ��a C�ZuY City/State2ip 1-414rep .21 dze, Phone (gobs) z 6 i 77oo Phone LDg ) SPECIMEN INFORMATION (use reverse side for additignal inf�pation) ANIMAL SPECIES: Breed 54 -A Age C P"A, ❑ Pet ❑ Stray gWild ❑ Unknown 'Why is animal to be tested? ❑ Human exposure Pet exposure ❑ Acting sick Symptoms: ❑ Aggression ❑ Ataxia ❑ Disorientation ❑ Lethargy ❑ Paralysis ❑ Salivation ❑ Seizures ❑ Unexplained wound ❑ Found dead JlOther /2y 77,j- Cause of death: ❑ Natural KKIIled Method S'k oT Date of death Vaccinated for rabies: ❑ Yes q No XUnknown Dale of vaccination Travel out of state: ❑ Yes ❑ No ZUnknown Where When Bitten by another animal within 12 months: ❑ Yes ❑ No Unknown If yes, by what? In what TOWN was animal found? In what C�OUN ? 4i11-r-7 EXPOSURE INFORMATION (use reverse side for additional informations PERSON(S) EXPOSED: Name Street City/State/Zlp Phone( ) Type of exposure: Cl Bite ❑Scratch ❑ Other Date of exposure Body site Severity of exposure Circumstance of exposure: ❑ Lick ❑ Unknown ❑ Capture ❑ Handling ❑ Specimen prep. l7 Unprovoked attack ❑ Provoked attack ❑ Indirect exposure ❑ Other Was person previously vaccinated? ❑ Yes ❑ No ❑ Unknown Did person receive rabies shots after incident? ❑ Yes ❑ No ❑ Unknown Physician/Hospital Phone ANIMAL(S) EXPOSED: Name /r'L1u.2 FoL v Species l s , ✓/�v� Owner glreet .City/State/Zjp /L%vr�,J/��rn ozovf Phone { j Type of exposure: Cl Bite ❑ Scratch ❑ Lick ❑ Unknown AOther t)-441 ��T/ elr� sYfkr4 Date of exposure i114 /g z Circumstances of exposure: Fight ❑ Vicinity ❑ Dead animal contact ❑ Other Was animal's rabies vaccination up-to-date? Yes ❑ No ❑ Unknown Did animal receive.rabies booster after incident? ❑ Yes ❑ No 'Unknown LABORATORY RESULTS'- FLUORESCENT RABIE.SANTISODY'TEST Test Date POSITIVE. (RABID) ❑ NEGATIVE:(NnOT'RASID):. COMMENTS:/t-tip (.✓L .11 c.( SPECIMEN UNSATISFACTORY ❑ REQUEST FOR RABIES EXAMINATION State Laboratory Institute, Virology Division Rabies Laboratory (617) 983-6385, -6387 SUBMITTER Ft7R LAB USO ANLY� '� ,i Lab No: es Agency Vo> la ti ,Qy/nr , „o�/I Owner or Person Who. Found Animal Street /y7 W. ✓/U,,,. Street /ua Fl be7. Sf City/State/Zip fik,„-•k> 1,4 PlZ7(( City/State/Ztp iy(e, I eIA r1A 0 c7/T Phone (S�y) ZYS 9yea- 'Phone ( 57? ) 3.3 Y - ns-' SPECIMEN INFORMATION {use reverse side for additional information) ANIMAL SPECIES: Breed _i2, ✓-,6 SEaf t -Age /0 O pet ❑ Stray ❑ Wild ❑ Unknown Why is animal to be tested? A Human exposure O Pet exposure ❑ Acting sick Symptoms: Aggression ❑ Ataxia ❑ Disorientation ❑ Lethargy ❑ Paralysis ❑ Salivation ❑ Seizures ❑ Unexplained wound ❑ Found dead ❑ Other Cause of death: O Natural 0 Killed Method�l- ' ,> : Date of death 7 it 63 Vaccinated for rabies: ❑ Yes W No ❑ Unknown Date of vaccination _ Travel out of state: ❑ Yes 5dNo ❑ Unknown Where When Bitten by another animal within 12 months: ❑ Yes ❑ No AAnknown If yes, by what? _ In what TOWN was animal found? P2n_,75 ke 1 c� In what COUNTY? EXPOSURE INFORMATION(use reverse side for additional information) PERSON(S)EXPOSED: Name `t) a 81-s Street _ 3� City/State/Zip 3. s Iy r`t/k OZs > Phone 23o - 7o7Y Type of exposure: 0 Bite ❑ Scratch ❑ Lick ❑ Unknown ❑ Other Date of exposure 7 /1.03 Body site& C�k-,- f Severity of exposure Seve.rz, Circumstance of exposure: ❑ Capture M Handling ❑ Specimen prep. ❑ Unprovoked attack ❑ Provoked attack ❑ Indirect exposure ❑ Other Was person previously vaccinated? NYes ❑ No ❑ Unknown Did person receive rabies shots after incident? A Yes ❑ No ❑ Unknown Physician/Hospital .SF, Phone s?; L A B O N L, Y ANIMALS) EXPOSED: Name Species Owner _ Street City/State/Zip Phone ( ) Type of exposure: ❑ Bite ❑ Scratch ❑ Lick ❑ Unknown ❑ Other Date of exposure Circumstances of exposure: ❑ Fight ❑ Vicinity ❑ Dead animal contact ❑ Other Was animal's rabies vaccination up-to-date? ❑ Yes ❑ No ❑ Unknown Did animal receive rabies booster after incident? 0 Yes ❑ No ❑ Unknown LABORATORY RESULTS - FLUORESCENT RABIES ANTIBODY TEST Test Date POSITIVE (RABID) ❑ NEGATIVE (NOT RABID)j SPECIMEN UNSATISFACTORY Cl COMMENTS: C 07/17/2003 TEU 11:00 FAX 508 261 7425 TORN OF MANSFIELD [a 001 N: 8:8:U:f• 9: Y::f•:J: *:i: S * r;::P. 8: S: q::P.. 9: A: a:e: TX REPORT a:a:r: *"1;xxs:s:a:s:s:*a:a:a:�:s::r.M TRANSMISSION OK TX/RX NO 1213 DEPT. ID 3652 CONNECTION TEL 915083391031 SUB —ADDRESS CONNECTION ID MANSFIELD P D ST. TIME 07/17 10:59 USAGE T 00'24 PGS. 2 RESULT OK TOWN OF MANSFIELD, MASSACHUSETTS Six Park Row, Mansfield, MA 02048 FAX COVER SHEET TOWN OF MANSFIELD BOARD OF HEALTH Date: 3 ( Time: From: Town of Mansfield Phone: 508-261-7360 Board of Health Fax: 508-261-7343 Six Park Row Mansfield, MA 02048 To: f C n s 50� 335_ 1031 Type of Form No of pages: Message: (Incl. cover sheet) 5 REQUEST FOR RABIES EXAMINATION State Laboratory Institute, Virology Division Rabies Laboratory (617) 983-6385,-6387 SUBMITTE Agency Street 0 ors uny/State/Zip /G7 �✓ /�/ pGr.� es z r ti P Phone (S Wig} ,2 r? /— 7_X616 Owner or Person Who. Found Animal ZOip"' . jijna tt iz� Street Z 3 sites- - City/State/Zip .rn r �s �� 0�( SPECIMEN INFORMATION {use reverse side for additional information) ANIMAL SPECIES: ran , / Breed _ �.G�. (� Age 6 ❑ pet ❑Stray <VAId ❑ Unknown Why is animal to be tested? ❑ Human exposure APet exposure ❑ Acting sick Symptoms: QAggression ❑ Ataxia Cl Disorientation ❑ Lethargy ❑ Paralysis ❑ Salivation ❑ Seizurcjs ❑ Unexplained wound ❑ Found dead Other Cause of death: 0 Natural XI(illed Method Vaccinated for rabies: ❑ Yes ❑ No Unknown Date of vaccination Date of death Sid_T_ Travel out of state: ❑ Yes E No XUnknown Where When _ Bitten by another animal within 12 months: ❑ Yes ❑ No Unknown If yes j by what? In what TOWN was animal found % G%n v,rr�id /�� In what COUNTY? _/�—sja EXPOSURE XNFORMATION(use reverse side for additional information) PERSON(S) EXPOSED: game A B u s E O N L, y Street City/State/Zip Phone ( ) Type of exposure: ❑. Bite ❑ Scratch ❑ Lick ❑ Unknown ❑ Other Dale of exposure Body site Severity of exposure Circumstance of exposure: ❑ Capture O Handling C] Specimen prep, ❑ Unprovoked attack ❑ Provoked attack ❑ Indirect exposure ❑ Othi:r _ Was person previously vaccinated? ❑ Yes ❑ No .❑ Unknown Did person receive rabies shots after incident? Cl Yes ❑ No ❑ Unknown Physician/Hospital _ Phone,___ Name Species„%t drys Ownerr"j Street 23 4✓ad.- s City/State/Zip >�/„ ✓✓f�- �Ltt' �r z - 4d Phone (SaP) y — 9.1 'y G Type of exposure ❑ Bite •❑ Scratch ❑ Lick El Unknown Other Date of exposure _ O Circumstances of exposure: Might ❑ Vicinity ❑ Dead animal contact ❑ Other Was animal's Tabies vaccination up-to-date? D14XYes ❑ No ❑ Unknown nimai receive rabies booster after incident? Yes D No ❑ Unknown LABORATORY RESULTS FLUORESCENT RABIES ANTIBODY TEST Test Date _ i _i POSITIVE (R.f,{, M 0 NEGATIVE (NOT RABID) I SPECIMEN UNSATISFACTORY 0 COMMENTS: ✓vt A,4, 14- ,f Cj �w/ REQUEST FOR RABIES EAMINATiON State Laboratory Institute, Virology Division Rabies Laboratory (617) 983-6385, -6387 6e;- SUBMITTER c• �J• o i % %' �� Agency ill Street�_ �=✓ ^,� ro, /�•/ S c 1 r� s r Owner or Person Who Found Animal 7s . �/, �r City/State/Zip ��Ns/ r/u, Street %G. C 10,.%lam Phone x� C)P4'Lie Z (�1S') 2 6 1— 7 9 0 0------.--_— City/State/Zip.ay -• s r� —.—�— ------- Phone SPECIlIIEN INF' ORMATION{use reverse side for additional information) ANIMAL SPECIES: —'—"--------___ -- —_ Breed S/c« lr - Why is animal to be tested? ,��—H exposure— Age L �S Pea ❑ Stray/ Symptoms: )(Pet exposure ❑ Acting sick "� Wild d Unknown ❑ Aggression ❑ Ataxia ❑ Disorientation ❑ Lethar ❑ Unex la' p med wound ❑ Found dead ❑ Other gY U Paralysis ❑ Salivation ❑Seizures Cause of death: ❑ N t a ural N Killed Method _fG c _ Vaccinated for rabies: ❑ Yes ❑ No Date of death Travel out of state: ❑ Yes lJnknown Date of vaccine ionUnknoZ °� Bitten by another animal within 122 months: ❑ yes El Where In what TOWN was animal found? v NO XUnkno s, When -- `��`� In what COUNTYr EXPOSURIn ORMATION(use reverse side PERSONS) EXPOSED: Name _' was Street City%State/ZipPhone 2— �— v� — -- — -- Type Of exposure: ❑ Bite ❑ Scratch ❑ Lick . ❑ Unknown •q Other Data of exposure z Body site �3 Severity of exposure N — Circumstance of exposure: ❑ Capture NHandling ElSpecimen prep, ElUnprovoked attack ❑ Provoked attack ❑ Indirect exposure ❑ Other Was person previously vaccinated? �— (J Yes No ❑ Unknown Did person receive rabies shots after incident? . ❑ Yes No ' ❑ Unknown Physician/Hospita _________ phone for additional information) AND4AL(S) EXPOSED: Name �7=r 2 %s 7ry s Species/4 -� -- — Owner --- Street / _- City/State/Zip- --- _tii cz y r Phone (1rzs ) Type of exposure: E1 Bite ❑ Scratch ❑ Lick f�l El Other Unknown Date of exposure _ 2y dJ _---- Circumstances of exposure: El Fight El Other Vicinity El Dead animal contact Was animals rabies vaccination up-to-date? ❑ Yes XNo ❑ Unknown Did animal receive rabies booster after incident? ❑ Yes ❑ No K Unknown U s e REQUEST FOR RABIES EXANW4ATION State Laboratory Institute, Virology Dlvislon Rabies Laboratory (617) 983-6385, -6386, -6387 SUBMITTER Street 59S Clly/State/zip Phone (5Z g) FDR LA6 U5E DNLY, =2�1 Owner or Person Who Found Animal I ' an tf 1'en fa I too Street on A City/State/zip— Phonesoc�) �3 G i 44VAarl AVIV" 1 UN (use reverse aide for additional Informa(ion) NIMAL SPECIES: d �" Breed p j Age ' Pat ❑ stray O WIH O Unknown Why Is animal to be tested? 'durnan exposure ❑ Pat exposure ❑ Actil sick Symptoms: ❑ Aggression 0 Ataxia ❑ Disorientation ❑ Lethargy ❑ Paratysis O Salivation. O Seizures Un!alrioc wound ❑ ound dos f to Olhar (r Q/ = t1� r'so( rjpp Cause of death: ❑Natural Kilted Method gi'q Date o(ddeeath_ �3 Vaccinated for rabies: X Yes ❑ No Date of vaccination C13 Travel out of state: ❑Yea ❑ No LJ-,Unknown Where '' When Bitten by another animal wflhln 12 months: ❑ Yea No Unknown If yes, by wlra(7 In what TOWN was animal(py�j7 � tIn y) e C In what OpUN7Y? EXPOSURE INFORMATION (use reverse'side for additional information) Name No f Street Uj Cily/State/ZP Phone( ) 14<rf Typo of exposure: )I Bite O Scratch ❑ Lick O Unknown ❑ Other_ Dale of exposure a Body slip�4 Severity of expdsure Clrcumslanca o) exposure: O Capture t9,Handling O Spedmen prep, ❑ Unprovoked attack p Provoked attack O Indirect exposure ❑ Other Was person previously vaccinated? Yes ❑ No ❑ Unknown Did person receive rabies shots after Inciden(? ❑ Yes ^ i❑ No nknown Physicia ospt I DC pI9 — Phone ANIMAL(S) EXPOSED: Name Spades Owner SIreeI City/Slafe0p Phone ( ) Type of exposure: ❑ Bite d Scratch O Other ❑ Lick ❑ Unknown Dale of exposure Circumstances of exposure: O Fight O Vicinity 11 Dead animal contact C7 Other Was animal's tables vaccination up-lo-dale? ❑ Yes ❑ No O Unknown Did animal receive tables booster after Incident? ❑ Yea O No d Unknown LABORATORY RESULTS FLU ORESCENTiRABIESANTIBODY TEST Tast.Date POSITIVE � 1 (RABID).❑ NEGATIVE (NOTRABID40' 1[ SPECIMEN UNSATISFACTORY COMMENTS: ❑ // 11 O N L Y 16-- REQUEST FOR RABIES EXAMINATION State Laboratory institute, Virology Divdadon Rabies Laboratory (617) 983-6385, -6386, -6387 SUBMITTER/\/ewEn'-�12vhd F(JR LA> USE ONLY ' Agency A a 1 vt r��h c C o.\te Iz Owner or Person Who Found Animal Street 5q5 w�� r ce�12�2 Si Sir"[. Q4 '0Me 2, 7f City/Slatelzip-M6Ae — i rYla ca3'CIt/Stale2iP CYl o, a M o Gti B Phone (S�) soas t s Phone (ems) - 3a - 9G -10 SPIyCIMEN INFORMATION (use reverse side for additional Information) ANIMAL SPECIES: Fe ttg4 Broad D5l Age ti6-8 z Pat ❑ Strny D Wlkd 0 Unknown Why Is animal to be tested? Human exposure ❑ Pet exposure E Acing sick Symptoms: O Aggression ❑ Ataxia ❑ Dlsotiontallon 0 Lethargy ❑ Paralysis ❑ Salivation O Seizures ,;gUnexplslnod wound ❑ Found dead ❑ OtherYothorwc Cause of death: ❑ Natural ,${ KIIbd Method Dale of death $12:6IQ`3 Vaccinated for rabies: 0 Yes ONO Unknown Dale of vaccination Travel out of stale: El Yes El No `nknown Where ''' When Bitten by another animnl within 12 months: 0 Yea 0 No Unknown If yes, by what? WN In what TOwas animal? 1Y0G V, rU\ In what QOUN ? EXPOSURE INFORMATION (use reverse side for additional information) PERSON(S) EXPOSED: Name Alan, Glazz� _ Streeter City/State/Zip A� ofie� iYl4 0.1S-Ic, Phone (nag, ) �p - a 51 ri Typo of exposure: )<�Blle 0 Scratch ❑ Lick 11 Unknown ❑ Other Date of exposure Body sib IF ., 4 0� t Q A Severily of exposure m; h Circumstance o) exposure: 0 Capture Handling 0 Specimen prep. ❑ Unprovoked attack ❑ Provoked attack 0 Indirect exposure L7 Other Was person previously vaccinated? XYes ❑ No ❑ Unknown Did person receW rabies shots after Incident? ❑ Yes VNo ❑ Unknown Physician/Hospital Phone ANIMAL(S) EXPOSED: Name Species Owner Street CitylState/➢p Phone ( ) Type of exposure: ❑ Bile 0 Scratch ❑ Lick 0 Unknown ❑ Other Dale of exposure Circumstances of exposure: 0 Fight Ci Vicinity 0 Dead animal contad ❑ Other Was anlrnal's tables vaccination up-Io-dete7 ❑ Yes ❑ No ❑ Unknown Did animal remfve rabies booster after Incident? 0 Yea ❑ No ❑ Unknown n LABORATORY RESULTS FLUORESOENTRABIES ANTIBODY TEST Teat:Date ' a _ u F OSITIVE (RAblb) ❑ NEGATIVE (NOT RABID) SPECIMEN UNSATISFACTORY ❑ E COMMENTS: r)ll ` 9� �i IL' )*^ �� ,/ I,n t � Ci 4 �, �� 'i✓ q,.t 0 N L y Client ID: 18255 Client Name: Hugh J. Mulligan Address: 1438 West Street Mansfield, Ma 02048 Phone: (508)261-9106,ext. Tag Number: 2188 Lot Number: 1215231A Producer: Fort Dodge K / MLV: Killed Virus Animal Rescue League Of Boston Veterinary Clinic 10 Chandler Street BOSTON, MA 02116 (617) 426-9170 Rabies Certificate Patient ID: 18255-5 Patient Name: Foxy Species: FELINE Breed: SIAMESE/MIX Sex: Neutered Male Color: tan/white Markings: Birthday: 00/00/0000 Weight: 10.30 pounds on 12/16/2003 Vaccination Date: Expiration Date: Staff Name: Dr. Bosmat Gal, D.V.M. License Number: 3834 12/1612003 1211612006 Client ID: 18255 Client Name: Hugh J. Mulligan Address: 1438 West Street Mansfield, Ma 02048 Phone: (508)261-9106,ext. Tag Number: 2189 Lot Number: 1215231A Producer: Fort Dodge K / MLV: Killed Virus II Animal Rescue League Of Boston Veterinary Clinic 10 Chandler Street BOSTON, MA 02116 (617)426-9170 Rabies Certificate Patient ID: 18255-6 Patient Name: Patches Species: FELINE Breed: SIAMESE/MIX Sex: Neutered Male Color: tan/white Markings: Birthday: 00/00/0000 Weight: 8.60 pounds on 12/16/2003 Vaccination Date: 12/16/2003 Expiration Date: 12/16/2006 Staff Name: Dr. Bosmat Gal, D.V.M. License Number: 3834 REQUEST FOR RABIES EXAM NATION F.OR'LA&USE::ONLY State Laboratory Institute, Virology Division Date: Received: Rabies Laboratory (617) 983-6385, -6387 Lab No:: SUBiN11TTER` , tom.✓ : /— /�„ r�J%EC✓ Agency z ,,,,+.,� o Owner or Person / s Who Found Animal A6, � Street _ J _ t t/ i'i s% Street 2U n. City/State2ip F��r.�.</;•,..;/%' �YI� uzayy-.3z,' Ci(y/SlatelZip�'zi' ?hone (joq ) 7_ C / - i atJ Phone S o5 ? SPECIMEN INFORMATION (use reverse side for additional information) ANIMAL SPECIES: Breed C.Arcelur✓ Age �•i,or ❑ Pet ❑ Stray "ild ❑Unknown Why is animal to be tested? ❑ Human exposure q Pet exposure ❑ Acting sick Symptoms: ,Q Aggression ❑ Ataxia ❑ Disorientation ❑ Lethargy ❑ Paralysis ❑ Salivation ❑ Seizures ❑ Unexplained wound ❑ Found dead ❑ Other Cause of death: ❑ Natural 'Killed Method S✓. T Date of death i z/✓C / 3 Vaccinated for rabies: ❑ Yes ❑ No !Rf Unknown Dale of vaccination . Travel out of state: ❑ Yes ❑ No 'R'Unknown Where When Bitten by another animal within 12 months: ❑ Yes ❑ No -34 Unknown If yes, by what? In what TOWN was animal found? i'Zlm s / ✓ / P In what COUN, ? _'t,'s i o%— EXPOSURE INFORAIA'TION (use reverse side for additional information) PERSON(S) EXPOSED: Name %fin%< C <s /„ ,.� n✓ Street "7 o /0 .,A S CG City/Slale/ZZp ,q,y.a_c /,f ,.cow oz,'iF Phone (�-ad') 3 3 9- 1> J o Type of exposure: ❑ Site ❑Scratch ❑ Lick ❑ Unknown ,OkOther o" nu e Date of exposure / 2 // e /t, Y Body site /7f1 a r Seventy of exposure f`7/ r / •,n-/ Circumstance of exposure: ❑ Capture ❑ Handling ' ❑ Specimen prep ❑ Unprovoked attack ❑ Provoked attack X Indirect exposure ❑ Other Was person previously vaccinated? ❑ Yes ( No ❑ Unknown Did person receive rabies shots after incident? ❑ Yes N No ❑ Unknown PhysicianlHospita Phone ANIMAL(S) EXPOSED: Name DA i S't/' Species CdN1,Vc Owner _ n /i'a C « / "I'l ✓ �ireet _ •z o D,• f scTci(,' City/State/Zip c 2 c r d' Phone(S'oC) ?75'- GG.7o Type of exposure: ❑ Site ❑ Scratch ❑ Lich ❑ Unknown ❑ Other Date of exposure ,/2 / tX 3 Circumstances of exposure: /t(Fight /'Vicinity ❑ Dead an contact ❑ Other Was animal's rabies vaccination up-to-date? ` Yes ❑ No ❑ Unknown Di animal receive.rabies booster after incident? ❑ Yes X'No ❑ Unknown A LABORATORY RESULTS'- FLUORESCENT RABIES -ANTIBODY 'TEST Test Date 8 I / u POSITIVE: (RABID) CO NEGATIVE (NOT'RASID)9.11 SPECIMEN UNSATISFACTORY ❑ s CCNIMBWT�5: q_,J a Y 12/.23/2003 TUE 11:02 FAX 508 261 7425 TOWN OF MANSFIELD 1A001 TX REPORT TRANSMISSION OK TX/RX NO 1519 DEPT. ID 3652 CONNECTION TEL 915083391031 SUB -ADDRESS CONNECTION ID MANSFIELD P D ST. TIME 12/23 11:02 USAGE T 00'27 PCs. 2 RESULT OK TOWN OF MANSFIELD, MASSACHUSETTS Six Park Row, Mansfield, MA 02048 FAX COVER SHEET TOWN OF MANSFIELO BOARD OF HEALTH Date;- Time: From: Town of Mansfield Phone: 508-261-7366 Board of Health Fax: ' 508-261-7343 Six Park Row Mansfield, MA 02048 To: 0 H r *1 _ 509 3 9 - 1031 Type of Form }a t No of pages: C2_1 Message: (Incl. cover sheet)