Copies of such reports should be mailed to the assigned Clinical Operations contact for the study. CONFIDENTIAL Page 101 of 102 Protocol: HERCEPTIN® + E75/GM-CSF Version 3.1 ML25749 05 March 2017 E-mail: SAFETY REPORTING FAX COVER SHEET Genentech Supported Research AE / SAE FAX No: (650) 225-4682 Alternate Fax No: (650) 225-5288 Genentech Study Number Principal Investigator Site Name Reporter name Reporter Telephone # Reporter Fax # Initial Report Date [DD] / [MON] / [YY] Follow-up Report Date [DD] / [MON] / [YY] Subject Initials (Enter a dash if patient has no middle name) [ ] - [ ] - [ ] SAE or Safety Reporting questions, contact Genentech Safety: (888) 835-2555 PLEASE PLACE MEDWATCH REPORT or SAFETY REPORT BEHIND THIS COVER SHEET CONFIDENTIAL Page 102 of 102 Protocol: HERCEPTIN® + E75/GM-CSF Version 3.1 ML25749 05 March 2017 APPENDIX O PROTOCOL TITLE: Combination immunotherapy with Herceptin and the HER2 vaccine E75 in low and intermediate HER2-expressing breast cancer patients to prevent recurrence STUDY DRUGS: HERCEPTIN® (Trastuzumab) E75 peptide (KIFGSLAFL, HER2/neu, 369-377) GM-CSF (Leukine®, Berlex) SPONSOR/INVESTIGATOR PROGRAM DIRECTOR George E. Peoples, MD PROTOCOL VERSION/DATE: 3.1 / 05 March 2017 INVESTIGATOR’S AGREEMENT / INVESTIGATOR’S SIGNATURE PAGE I have read the protocol described above.