VS 6-4A Investigation for Evidence of Tuberculosis (Potential So

U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH
INSPECTION SERVICE
VETERINARY SERVICES

INVESTIGATION FOR EVIDENCE OF TUBERCULOSIS
(Potential Source Herds)

CODES - (The following codes are to be used under the respective column headings)
REASON FOR TEST (20)

HERD TEST LESION CODE
(21)

1.
2.
3.
4.

AREA
HERD ACCREDITATION OR REACCREDITATION
COMPLY WITH MILK ORDINANCES
SALE, SHOW, INTERSTATE, INTRA-STATE OR
EXPORT SHIPMENT
5. IMPORTED ANIMALS (Interstate or international)
6. RETEST OF QUARANTINED HERD
7. AFTER TRACING ANIMALS WITH LESIONS
REGULAR KILL
8. AFTER TRACING REACTING ANIMALS
9. AFTER TRACING EXPOSED ANIMALS
10. OTHER (Miscellaneous)

SEX (34)
1. FEMALE

DENOTES ALL LOCATIONS
OF LESIONS FOUND IN ALL
OF THE REACTORS ON A
HERD TEST

2. MALE
3. STEER

BREED (33)
1.
2.
3.
4.
5.

HOLSTEIN
HEREFORD
JERSEY
GUERNSEY
ANGUS

6.
7.
8.
9.

AYRSHIRE
SHORTHORN
SWISS
OTHER

REACTOR LESION (35)
0.
1.
2.
3.
4.
5.
6.
7.
8.
9.

LAB RESULTS (36)

NO P.M. RPT.
NGL
SKIN
HEAD
THORACIC
ABDOMINAL
HEAD & THORACIC
HEAD & ABDOMINAL
THORACIC & ABDOMINAL
HEAD & THORACIC &
ABDOMINAL

1.
2.
3.
4.

COMPATIBLE
SUGGESTIVE
NOT SUGGESTIVE
NO SPECIMEN

SECTION 1 - OWNERSHIP AND IDENTIFICATION OF REACTOR(S) PURCHASED FROM A KNOWN SOURCE
NAME AND ADDRESS OF OWNER OF INFECTED HERD (include State, ZIP Code, and Premises Identification
Number if known)

COUNTY

NAME (2-7)

OWNER CLASS (Check one) (13)

STATE

1. FARMER

3. STOCKYARD

2. DEALER

4. SALES RING

COUNTY
(8-10)

1.
3.
DATE TEST
READ (Mo.,
day, yr.)(14-19)

REASON
FOR TEST
(20)

STATE
(11-12)

HERD
LESION
CODE (21)

The following animal reacted to the tuberculin test, and was reported to have been purchased from the previous owner named below. All herds with which this animal may
have been associated previously Should be investigated for evidence of TB.
IDENTIFICATION
TAGS OR
TATTOO
(22-30)

REACTOR
TAG

AGE
(31-32)

BREED
(33)

SEX
(34)

ORIGIN
REACTOR

LESION
(35)

LAB
RESULTS
(36)

DATE PURCHASED

DESCRIPTION (Color, markings, horn)
(Registration No. and name if purebred)

MONTH
(37-38

4
SECTION II - PREVIOUS OWNER OF ANIMAL FOUND TO BE A REACTOR
ADDRESS (Include Premises Identification Number, if known)

PURCHASED FROM (Herd to be investigated)

COUNTY

OWNER CLASS (Check one)

STATE

1. FARMER

3. STOCKYARD

2. DEALER

4. SALES RING

SECTION III - INTERSTATE MOVEMENT (Furnish the following information when interstate movement is involved)
1. SERIAL NUMBER, DATE, CONSIGNOR'S NAME AND
ADDRESS, AND OTHER PERTINENT INFORMATION SHOWN
ON THE HEALTH CERTIFICATE COVERING THE ANIMAL
WHEN MOVED INTERSTATE. (If the health certificate cannot
be located, a statement to the effect should be made.)
2. IF THE ANIMAL WAS RETAGGED AFTER LEAVING THE
STATE OF ORIGIN - LIST THE ORIGINAL TAG NUMBER IF
KNOWN, OR GIVE ANY OTHER PERTINENT INFORMATION
THAT MAY MAKE TRACING POSSIBLE.
3. ALL TEST DATES AND RESULTS OF HERD TESTS IN
WHICH THE SUBJECT ANIMAL WAS A MEMBER AFTER IT
HAS ENTERED THE RECEIVING STATE. (If no tests have
been made, it should be so indicated.)

4. DISTRIBUTION: 1 COPY - VETERINARIAN IN CHARGE; 1 COPY - VS, RIVERDALE, MD.; 1 COPY - STATE VETERINARIAN
REPORT SENT TO OFFICIALS IN STATE OF ORIGIN OR
INSPECTOR

VS FORM 6-4A
(JUN 2005)

SIGNATURE OF VETERINARIAN IN CHARGE OR DESIGNEE

DATE

YEAR
(39-40)

SECTION IV - REPORT OF RESULTS OF INVESTIGATION AFTER TRACING A REACTOR
PREVIOUS OWNER (41)

ADDRESS (Include Premisis Identification Number if known)

NAME (42-47)

COUNTY
(48-50)

STATE
(51-52)

1
COUNTY

HERD
TEST
RESULT
S

STATE

OWNER CLASS
(Check one) (53)

DATE TEST READ
MONTH
(59-60)

DAY
(61-62)

YEAR
(63-64)

HOW WAS REACTOR LISTED IN PART 1 ACQUIRED BY THIS
OWNER (Check one) (54)

1. FARMER

3. STOCKYARD

1. RAISED ON FARM

3. PURCHASED UNK. SOURCE

2. DEALER

4. SALES RING

2. ORIGIN UNKNOWN

4. PURCHASED KNOWN SOURCE

NUMBER OF
ANIMALS TESTED
(65-67)

REACTORS
(68-69)

HERD TEST
LESION
CODE (70)

DATE PURCHASED
(Mo., yr.) (55-58)

NUMBER OF REACTORS
NO P.M.
REPORT (71)

NGL
(72-74)

SKIN
(75-76)

REMARKED CODE
(79-80)

INTERNAL LESION
(77-78)

REMARKS (Reason test not made on this herd)

PREVIOUS OWNER (41)

ADDRESS (Include Premisis Identification Number, if known)

NAME (42-47)

COUNTY
(48-50)

STATE
(51-52)

2
STATE

COUNTY

HERD
TEST
RESULTS

OWNER CLASS
(Check one) (53)

DATE TEST READ
MONTH
(59-60)

DAY
(61-62)

YEAR
(63-64)

HOW WAS REACTOR LISTED IN PART 1 ACQUIRED BY THIS
OWNER (Check one) (54)

1. FARMER

3. STOCKYARD

1. RAISED ON FARM

3. PURCHASED UNK. SOURCE

2. DEALER

4. SALES RING

2. ORIGIN UNKNOWN

4. PURCHASED KNOWN SOURCE

NUMBER OF
ANIMALS TESTED
(65-67)

REACTORS
(68-69)

HERD TEST
LESION
CODE (70)

NUMBER OF REACTORS
NO P.M.
REPORT (71)

NGL
(72-74)

SKIN
(75-76)

INTERNAL LESION
(77-78)

DATE PURCHASED
(Mo., yr.) (55-58)

REMARKED CODE
(79-80)

REMARKS (Reason test not made on this herd)

PREVIOUS OWNER (41)

ADDRESS (Include Premisis Identification Number if known)

NAME (42-47)

COUNTY
(48-50)

STATE
(51-52)

3
COUNTY

HERD
TEST
RESULTS

STATE

OWNER CLASS
(Check one) (53)

DATE TEST READ
MONTH
(59-60)

DAY
(61-62)

YEAR
(63-64)

HOW WAS REACTOR LISTED IN PART 1 ACQUIRED BY THIS
OWNER (Check one) (54)

1. FARMER

3. STOCKYARD

1. RAISED ON FARM

3. PURCHASED UNK. SOURCE

2. DEALER

4. SALES RING

2. ORIGIN UNKNOWN

4. PURCHASED KNOWN SOURCE

NUMBER OF
ANIMALS TESTED
(65-67)

REACTORS
(68-69)

HERD TEST
LESION
CODE (70)

NUMBER OF REACTORS
NO P.M.
REPORT (71)

NGL
(72-74)

SKIN
(75-76)

REMARKED CODE
(79-80)

INTERNAL LESION
(77-78)

REMARKS (Reason test not made on this herd)

REPORT OF RESULTS OF INVESTIGATION SENT TO VETERINARY SERVICES, RIVERDALE, MD
SIGNATURE OF VETERINARIAN IN CHARGE OR DESIGNEE

DATE PURCHASED
(Mo., yr.) (55-58)

DATE

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