Informed Consent Form for TAMU CVM Teaching Laboratories
This form is to be completed for all Texas A&M University College of Veterinary
Medicine & Biomedical Sciences-associated teaching laboratories/demonstrations that utilize
non-University-owned animals. Each item should be addressed concisely. If an item does not
apply to a specific laboratory/demonstration, please indicate this under the appropriate item. This
form should be submitted to the CVM Clinical Research Review Committee for review and
approval prior to the initiation of the laboratory/demonstration.
I. Owner of animal: ____________________________
Address:
Phone #:
____________________________
____________________________
____________________________
____________________________
II. Position of owner (i.e. faculty, student, staff, employee, etc.)
III. Animal Identification:
Name: __________________________
Breed: __________________________
Age: __________________________
Sex: __________________________
IV. Purpose of Teaching Event (identify class/lab/demonstration)
VAPH 948, Regulatory Issues for the Practitioner
Tuberculosis testing and brucellosis vaccination wet lab
Chutes behind Large Animal Research Surgery, Building 1192, Vet Med Park
V. Expected Duration of Animal Participation
Animals will be needed for the duration of the two hour laboratory.
VI. Description of Procedures
Animals will be held in holding pens for the majority of the laboratory session. Animals
will then be restrained in a squeeze chute and procedures associated with official
brucellosis vaccination will be performed under supervision of a TAHC regulatory
veterinarian. Brucellosis vaccination procedures include the subcutaneous injection of
2 ml (1.0-3.4 x 1010 colony forming units) RB51 vaccine, placement of an official
vaccination tag in the right ear, and applying an official tattoo on the inside of the right
ear.
VII. Possible Discomfort and Risks to animal
There is a slight possibility of side-effects associated with brucellosis vaccination. These
include immediate allergic reactions such as anaphylactic shock, abscess or granuloma
formation, and generalized pain and swelling. The placement of the official ear tag and
tattoo can cause mild pain and discomfort. Improper placement of the ear tag could also
result in infection, tissue necrosis, and loss of tag. Application of the tattoo may cause
self-limiting bleeding should it be placed too close to the veins adjacent to the ear
cartilages.
VIII. Possible Benefits of Participation to animal
Participating cattle will be officially vaccinated for brucellosis. Official vaccination not
only protects cattle from infection upon exposure to Brucella abortus, but also satisfies
some of the requirements for interstate movement of cattle.
IX. Compensation for Therapy of Injuries to animal
This laboratory does not provide compensation or therapy for any injuries or loses that
may occur as a result or participation.
X. Voluntary Participation and Right To Withdraw
Participation in this laboratory is voluntary, and you may withdraw from any time
without penalty. Refusal to participate or withdrawal from the laboratory will in no way
affect the care to which the participants are otherwise entitled.
XI. Unforseen Risks to animal
Unforeseen risks may arise during the course of the laboratory. The course coordinator
or research staff will promptly inform participants of any developments that may affect
their willingness to participate.
XII. Contact Person (faculty in charge)
Dr. Geoffrey T. Fosgate
Department of Veterinary Integrative Biosciences
College of Veterinary Medicine & Biomedical Sciences, TAMU
College Station, TX 77843-4458
(979) 845-3203 (regular hours)
(979) 823-4436 (at home)
gfosgate@cvm.tamu.edu
XIII. This teaching laboratory/demonstration has been reviewed and approved by the
Clinical Research Review Committee of the Texas Veterinary Medical Center. If questions
arise regarding your rights as a participant, the Clinical Research Review Committee
Contact Person listed below may be contacted.
Dr. Bhanu Chowdhary
Associate Dean for Research & Graduate Studies
College of Veterinary Medicine & Biomedical Sciences
Texas A&M University
College Station, TX 77843-4461
979-845-5092
XIV. Authorization for Participation
I, the undersigned, do hereby certify that I am the owner (or duly authorized agent of the
owner) of the above-described animal; that I hereby consent to have my animal participate in the
above described laboratory; that I understand that some risk always exists in performing
veterinary procedures and that I am encouraged to discuss any concerns I have about those risks
with the laboratory instructor before the procedure(s) is/are initiated; and that I consent to having
photographs taken of my animal, if deemed appropriate by the laboratory instructor.
I have read and fully understand the terms and conditions set forth above.
Signature of Owner or Agent___________________________
Date__________________
Phone Number(s) at which owner can be reached____________________________________
Witness:___________________________________________
Date__________________