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AusVaxSafety myocarditis long-term follow-up program

AusVaxSafety is actively engaging with individuals in Australia diagnosed with myocarditis after COVID-19 vaccination and following them up over an 18-month period to monitor their health progress and outcomes. If you were diagnosed with myocarditis following COVID-19 vaccination and would like to take part in the program, please complete the eligibility form below.
Full name(Required.)
Email address(Required.)
When were you diagnosed with myocarditis?(Required.)
If you can't remember the exact date, please put a rough estimate in.
What state or territory do you live in?(Required.)
Was your myocarditis diagnosis reported to your state or territory health department or the Therapeutic Goods Administration (TGA)?(Required.)
More information on the AusVaxSafety myocarditis long-term follow-up program is available on the AusVaxSaefty website.

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