VS 4-108A Origin of Reactors/Herd Additions

See Notice/Instructions on Reverse
U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

ORIGIN OF REACTORS/HERD ADDITIONS

See reverse for additional OMB statement
1. NAME OF HERD OWNER
INSTRUCTIONS: If animals are traceable to a
herd source, obtain all supporting documents
(i.e., health certificates, sales yard releases,
3. COUNTY
4. HERD NO.
brand inspection records, test charts, sales
slips, etc.)

C

7. Have arrangements been made to contact owners of source herds of all
purchased suspects and reactors?
Yes
VS FORM 4-108A
APR 2009

No (If no, explain on reverse)
Previous editions obsolete

D

E

8. SIGNATURE OF VETERINARIAN

F

G

I

J

CODE

Results

H

Specimen
Submitted

Vac. Status

B

Breed

A

Age when
purchased

Sex

SUPPLEMENTAL TO VS FORM 4-108
6. LIST ORIGIN OF REACTORS AND HERD ADDITIONS (Identify each MCI and initial herd reactor – negative additions need not be listed individually.)
SOURCE
IDENTIFICATION
CULTURE
Most Recent
Status of
Date
Animal(s)
Tag No’s
Brand
NAME AND ADDRESS
Added
“M,” “R,”
(Include all reactors both raised and purchased)
or “N”

OMB Approved 0579-0047
2. DOCUMENT NUMBER
5.
PAGE

OF

PAGES

REMARKS
Date of last calving
(Circle if abortion)
Disposition of calf
(Id. if in herd)

STATUS AT
ENTRY TO
HERD

L

M

K

9. DATE

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0047. The time
required to complete this information collection is estimated to average 4 hours per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
_________________________________________________________________________________________________________________________

NOTICE TO HERD OWNERS
Herd Owners (Managers or Agents) of herds of brucellosis affected livestock must be advised that information
is given voluntarily to assist in the elimination of brucellosis from the livestock population. Cooperation of all
affected herd owners (Managers or Agents) is needed to complete a thorough epidemiologic investigation to
identify the source of the disease, the method of spread and the possible dissemination of new herds. The
authorities under which the brucellosis program is conducted are contained in 21 U.S.C. 111, 112, 114, 114a,
114a-1, 115, 120, 121, 125, and 134a-f and Title 9, Code of Federal Regulations, Parts 51 and 78.

INSTRUCTIONS
The purpose of this form is to record information of epidemiologic importance individually for: (1) each MCI
reactor (if any), (2) each reactor on the initial herd test, and (3) by lot for any other purchases. In most cases,
this should cover the 2-year period prior to discovery of the infection but the time period may vary upon
epidemiologic findings.
1-4.

From 4-108. Item 2 is the preprinted number on the 4-108.

6-I.

5.

Indicate which page of 4-108A this is and how many total
pages were completed.

Record the brucella vaccination status as “CV” (calfhood),
“AV” (adult), “NV” (not vaccinated), or “UN” (unknown).

6-J.

6-A.

Record the complete legal name and mailing address of the
supplier for each animal or group of animals added to the
herd. List each MCI reactor (if any) on a separate line. List
each farm reactor on the initial herd test on a separate line.
List each purchase (one purchase lot per line) for all other
animals added to the herd over the past 2 years (or longer at
the discretion of the investigator).

Indicate material submitted for brucella culture. Use “T” for
lymphoid and other glandular tissue. Use “F” for fetus,
placenta, or uterine exudates. Use “M” for milk including any
udder secretion. If two or more were submitted, list one
above the other.

6-K.

Record brucella culture results as “N” (negative), “1” (type 1),
“2” (type 2), “4” (type 4), “19 S” (Strain 19), “S” (suis), and
“U” (contaminated or unsatisfactory). If milk, placentas,
and/or tissues are submitted, record the results for each
material.

6-L.

For reactors, record the date of last calving (circle the date if
it was an abortion or a full term dead or weak calf), indicate
where the calf is now, and any other information considered
pertinent. For purchase lots, record pertinent information
such as culled aborters, etc.

6-M.

Enter the respective code number(s): 1-untested, 2-negative
test, 3-from a brucellosis certified free herd, 4-from a
certified free (or class A) area.

7.

Indicate “yes” if you are going to contact all herds of origin of
reactors or other suspicious purchases. Indicate “no” if you
are not going to contact all and explain on back of form.

8.

Signature of Veterinarian responsible for the completion of
this investigation.

9.

Date signed by the Veterinarian responsible for this
investigation.

6-B.

List the date the present owner acquired control of the
animal(s).

6-C.

Indicate the latest status of the animal(s) by “M” (MCI
Reactor), “R” (herd reactor), or “N” (negative).

6-D.

List the identification other than brand for each reactor
animal when purchased if known and when found to be a
reactor and the reactor tag number. For purchase lots,
indicate the number of animals involved and list the tag
range (if in series), State codes, or other available
identification.

6-E.

List all brands on the animal(s) or listed on any permit
received with the animals.

6-F.

Indicate “F” for female and “M” for male. For purchase lot
data, record the number of each.

6-G.

Indicate the age when purchased. For purchase lots, record
the age range and the average or most frequent age.

6-H.

Record the breed of reactors, if known. If nondescript,
record the most probable breed by appearance, etc. For
purchase lots, record the predominant breed or as mixed
beef or mixed dairy.

Attach copies of any supporting documents that might help trace additions. This could be market invoices
and release slips, brand inspections, health certificates, receipts, etc.

VS FORM 4-108A (Reverse)

Privacy Act Notice
Veterinary Services – Brucellosis Information System and Brucellosis Recording and Reporting System
Authority: 21 U.S.C. 111, 112, 114, 114a-1, 115, 120, 121, 125, 134a-134f and title 9, Code of Federal Regulations, part 51 and
part 78.
Purpose and Routine Uses:
Routine uses of records maintained in the system, including categories of users and the purposes of such uses:
1)
2)
3)
4)
5)
6)
7)

Detecting the foci of infection to reduce the rate of spread of infection to new herds;
Evaluating brucellosis program activities of State, Federal, and contractual personnel;
Preparing mailing labels and preaddressed forms to enhance field activities;
Evaluating program effectiveness;
Detecting factors of epidemiologic importance in containing or eliminating foci of infected herds;
Assuring that brucellosis indemnities are promptly and properly paid;
Notification of livestock owners with the animals at high risk of exposure to brucellosis because of livestock movements or
an outbreak of disease or presence of quarantined premises in a community;
8) Referral to the appropriate agency, whether Federal, State, local, or foreign, charged with responsibility of investigating or
prosecuting a violation of law concerning animal disease control and eradication, or of enforcing or implementing a
statute, rule, regulation, or order issued pursuant thereto, of any record within this system when information available
indicates a violation or potential violation of law concerning animal disease control and eradication, whether civil, criminal,
or regulatory in nature, and either arising by general statute or particular program statute, or by rule, regulation, or court
order issued pursuant thereto;
9) Litigation by the Department of Justice when the agency, or any component thereof, or any employee of the agency in his
or her official capacity, or any employee of the agency in his or her individual capacity where the Department of Justice
has agreed to represent the employee, or the United States, where the agency determines that litigation is likely to affect
the agency or any of its components, is a party to litigation or has an interest in such litigation, and the use of such
records by the Department of Justice is deemed by the agency to be relevant and necessary to the litigation; provided,
however, that in each case, the agency determines that disclosure of the records to the Department of Justice is a use of
the information contained in the records that is compatible with the purpose for which the records were collected;
10) Use in a proceeding before a court or adjudicative body before which the agency is authorized to appear, when the
agency, or any component thereof, or any employee of the agency in his or her official capacity, or any employee of the
agency in his or her individual capacity where the agency has agreed to represent the employee, or the United States,
where the agency determines that litigation is likely to affect the agency or any of its components, is a party to litigation
or has an interest in such litigation, and the agency determines that use of such records is relevant and necessary to the
litigation; provided, however, that in each case, the agency determines that disclosure of the records to the court is a use
of the information contained in the records that is compatible with the purpose for which the records were collected; and
11) Response to a request from a congressional office from the record of an individual made at the request of that individual.
To certain Federal and State animal health officials to conduct, analyze, and report on the progress of animal disease
control or surveillance programs.

Disclosure: Furnishing this information is voluntary; however, failure to furnish this information may impede brucellosis
eradication activities.

Form Copy Designations
PART 1-HERD FILE
PART 2-CATTLE DISEASES STAFF,
RIVERDALE, MD (Free Areas only)
PART 3-STATION EPIDEMIOLOGIST
PART 4- STATE OR FEDERAL FIELD
VETERINARIAN