Q1 – 5: Product Identification

*A Gene Therapy Product (2003) form will be completed for each product administered

Question 1: Name of Product

The name of the product reported will be auto populated from what was reported on the Pre-TED (F2400) form.

Questions 2 – 5: Specify the identifier(s) associated with this gene therapy product (check all that apply)

Indicate the identifiers (Product ID, Batch Number, or Lot Number) associated with this gene therapy product. At least one identifier should be reported. Check all that apply.

• Gene therapy product ID: Product IDs can be numeric or alphanumeric and are found with the product bag or shipping manifest.
• Batch number: Batch numbers can be numeric or alphanumeric and are available with the information that comes with the product
• Lot number: Lot numbers can be numeric or alphanumeric and are available with the information that comes with the product
  

Section Updates:

Question Number	Date of Change	Add/Remove/Modify	Description	Reasoning (If applicable)
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CIBMTR® (Center for International Blood and Marrow Transplant Research) is a research collaboration between the Medical College of Wisconsin and NMDP.