16 AUG 192021 at FAVN REPORT FORM HN DN) Rabies Antibody Titer for Export Animals The Rabies Laboratory Phone: 785-532-4483 21,044710--) - Kansas State University Fax: 785-532-4474 osrter2ca4 2005 Research Park Circle Email: rabies@vet k-state.edu§ ———— Kansas State Veterinary Manhattan, KS 66502 http://w wdl.org/rabies-laboratory/ DIAGNOSTIC LABORATORY Results are reported on this form, Please complete oncline and printout IC handwritten, prin clearly. Handwritten information is subject to interpretation by laboratory personnel, Once submitted, information cannot be alieed*. Required fields are bolded. Destination of animal being exported: UNITED STATES OF AMERICA, Destination information sor laboratory report dsribution on Submitting Clinic: TEST LABORATORIO SAS Phone: 5742542298 Veterinarian Name: LUIS RUA CEBALLOS: Fax; _ 5742542298 Clinic Mailing Address: CRA 45 D # 60-16- BARRIO PRADO CENTRO pri, _sitowrowurainanaicon City; MEDELLIN State/Country: ANTIOQ ; COLOMBIA zipcode: 050012 Owner Name: First JENNIFER Last GRANADA MONCADA Animal Name: COCO Microchip Number: 900 217 000 290 784 Serum Draw Date am/dyyyyy AUS) 12 1 2021 {thre are tac microchip aber, ony the fat oe wi On He Peal Tbe] aw Species/Breed: CANINE/SHIHT-2U See MIMMFEQ Age MARCH/O1/2018 Rabies Vaccination History, JULY/10/2021-RABISIN/MERIAL/470733, Vaccination History for laboratory reference only Please elude upto three recent vxcinalions dates aval Samples and st data may be used for general research without compromising clint conideataliy. [L} Op Oat Signature of Veterinarian: atid Lid Date tmmayyyyy AUS _15 , 2021 Signature afrms that the above information Is Correct and he microchip raonber has been verVied ‘Test will be cancelled if sample tube is unlabeled or arives without the microchip number* LABH: R21-0447102 Rec Date: AUGUST 19, 2021 Microchip #: 900217000290784 ‘The serum sample has been tested for antbodies to rabies ‘us by the OIE-FAVN test and found to have ater of, >is 4.56 [U/mL Jamie Henningson DVM, PHD, DACVP ~ KSVDL Director ‘Ate 20 Ut above date an accep bin a ee a be ‘Purpose of export For epot vefonion, go wane kav sable brary EEE For Lab Use Only: Opened by [HS)Aht Processed By. NO 8/14/20. Transferred By: WOM Payment Received: 2% 2042036 ig + Pleas se instretons for FAVN submission and reporting a hip Aww kau ulubislsboaton’ This submission form ie lega and binding contract hawoen ESVDE and th submiting eatiy, Specimens submitted become the property of the KSVDL. All evs, to inclode collestion es, are the ‘aponsiby ofthe submiting entity ill entities ust adore tothe filing pole. Peek may be paid by check (payable to Kansas Sate Universit), ‘ret ean, mone) order. or elstoni bank trnafer 1.5% nance charge wil be esessed an ll charges over 60 days Vm?