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.

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* Full name

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* Email address

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* When were you diagnosed with myocarditis?

If you can't remember the exact date, please put a rough estimate in.

Date

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* What state or territory do you live in?

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* Was your myocarditis diagnosis reported to your state or territory health department or the Therapeutic Goods Administration (TGA)?

Yes

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More information on the AusVaxSafety myocarditis long-term follow-up program is available on the AusVaxSaefty website.

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