Report Adverse Reactions

Protect the Pets!

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PTP Vets

If you have a pet that has experienced an adverse vaccine-related reaction, please complete the form below.

The data collected will be used to further the mission of Protect the Pets.

Adverse Reaction Reporting Form (one pet per form please)

What vaccine(s) did your pet react to? *

Rabies Only Rabies plus other vaccines Other vaccines

* Indicates required field

Date of Vaccine *

Date of 2nd Vaccine *

Date of 3rd Vaccine *

Name of Vaccine *

Manufacturer of Vaccine *

Lot Number *

Expiration Date *

Name of 2nd Vaccine *

Manufacturer of 2nd Vaccine *

Lot Number of 2nd Vaccine *

Expiration Date of 2nd Vaccine *

Name of 3rd Vaccine *

Manufacturer of 3rd Vaccine *

Lot Number of 3rd Vaccine *

Expiration of 3rd Vaccine *

Upload Vet's Diagnostic Notes *

Max file size: 20MB

Upload Additional Documentation *

Max file size: 20MB

Necropsy Report *

Max file size: 20MB

Upload A Photo of Your Pet *

Max file size: 20MB

Name *

First

Last

Email *

Phone Number *

Address *

City *

State/Region/Country *

Zip *

Name of Pet *

What Sex Is Your Pet? *

Male Female

Age of Pet *

Pet's Weight *

Pet's Breed/Mix *

Is Your Pet Spayed or Neutered? *

Yes No

Veterinarian's Name *

Clinic Name *

Vet's Phone Number *

Vet's Email Address *

Reaction Category *

Diagnosed Reaction Suspected Reaction

Date that Reaction Began *

Date of Death *

Reaction Type *

Comments-Previous Vaccine History *

Would You Like Your Pet's Photo included on the Memorial Page? *

Yes No

Can Dr. Robb, Protect the Pets Share Your Story? *

I agree to share my pet's story. i do not want my story shared.

By checking yes, you agree to allow Protect the Pets tand Dr. Robb to share your story about your pet .

Submit

Home
About Dr. Robb
Educate & Participate
PTP Vets

If you have a pet that has experienced an adverse vaccine-related reaction, please complete the form below. ​The data collected will be used to further the mission of Protect the Pets.

Adverse Reaction Reporting Form (one pet per form please)

If you have a pet that has experienced an adverse vaccine-related reaction, please complete the form below.

The data collected will be used to further the mission of Protect the Pets.