Online Questionnaire
Questionnaire (PDF)
The National Vaccine Information Center has operated a Vaccine Reaction Registry since 1982. Before you fill out this Gardasil Vaccine questionnaire, please take a few minutes to fill out a short Vaccine Reaction Report to NVIC's Vaccine Reaction Registry at http://www.nvic.org/Forms/CivilianReactionPage.aspx or https://vaers.hhs.gov/esub/index
NVIC's Gardasil Network Development Project is gathering information about Gardasil vaccine reactions to help identify common symptoms and high risk factors. If you, your child or other family member has developed a health problem following a Gardasil shot, please consider filling this questionnaire out and returning it to NVIC.
Personal identifying information will not be shared with anyone outside of NVIC without permission. Published reports using information from Gardasil questionnaires, which will be used to analyze adverse health events following vaccination with Gardasil, will not include any personal identifying information.
It will take approximately 30 minutes to fill out this questionnaire. Have your shot record with dates the Gardasil shot or shots were given. Return the completed questionnaire to NVIC, 407-H Church St., Vienna, VA 22180 or fax to 703-938-5768.
Thank you for taking the time to fill out this Gardasil questionnaire. The information generated will help doctors who care find out if some girls and women are at higher risk than others for suffering a vaccine reaction and a better understanding of how those already injured may be able to heal from their injuries.
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