This government document is issued by Department of Health for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:-o2sxg2obgu&q=https://www.health.pa.gov/topics/Documents/Programs/Immunizations/VFC/Instructions%2520for%2520Completing%2520the%2520Spoiled_Expired%2520Returnable%2520Form.pdf&sa=U&ved=2ahUKEwiI_dG5sdD8AhW2SfEDHVUWBuM4KBAWegQIBBAB&usg=AOvVaw28CGPP02iCvpnylznLsiE0