(1) The date of each vaccination;
(2) The manufacturer and lot number of the vaccine used for each;
(3) Any other identifying information on the vaccine used; and
(4) The name and title of the health care provider.
(b) Within twenty-four hours after an adverse reaction is recognized by any health care provider who has administered pertussis vaccine to an individual and has reason to believe that the individual has had a major adverse reaction to the vaccine, such health care provider shall:
(1) Record all relevant information in the individual's permanent medical record; and
(2) Report the information including the manufacturer's name and lot number to the county health officer who shall immediately forward the information to the department. On receipt of the information, the department shall immediately notify the vaccine manufacturer, and the United States centers for disease control.