Reporting of Suspected Supply Shortages by the Consumer

You suspect a vaccine supply shortage, which is not included in the PEI vaccine supply shortage list? Please contact us using the form below.

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(*) mandatory fields. All other fields are optional.

Your data

Your zip code *

Your name

Email

Which vaccine is it? *

Is it a flu vaccine? *

yes no

Is it a COVID-19 vaccine? *

yes no

If yes (COVID-19 vaccine):

Number of vials ordered

Number of vials received

You are *

Pharmacist Registered doctor or private doctor Company doctor Hospital doctor Private citizen

The receipt should run over *

Pharmacy Wholesaler Direct sale at the manufacturer

If "pharmacy" was selected:

How many pharmacies did you contact?

1 2 3 (or more)

Name of the "pharmacy / pharmacies"

Do the pharmacies have the same zip code?

yes no

If not, which one?

Alternatively: Online pharmacy

yes no

If "wholesaler" was selected:

How many wholesalers have you contacted?

1 2 3

Name(s) of the Wholesaler

If "Direct sell by manufacturer" was selected:

Which manufacturer did you try to buy the product from? Please select AJ Vaccines A/S (DE Distribution: Pfizer Pharma) Astra Zeneca Baxter Chiron Behring GSK-GlaxoSmithKline MedImmune MSD Sharp & Dohme Mylan Healthcare Novartis Pfizer Pharma Sanofi-Aventis Deutschland Seqirus Name of another Manufacturer

Name of another Manufacturer

email text