{"id":35,"date":"2023-08-10T18:26:59","date_gmt":"2023-08-10T18:26:59","guid":{"rendered":"https:\/\/report.tank.ca\/?page_id=35"},"modified":"2023-08-10T18:26:59","modified_gmt":"2023-08-10T18:26:59","slug":"tank-report-bexsero","status":"publish","type":"page","link":"https:\/\/report.tank.ca\/index.php\/tank-report-bexsero\/","title":{"rendered":"BEXSERO- HSI Report"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f33-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/35#wpcf7-f33-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"33\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f33-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:33,&quot;conditions&quot;:[],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false}}\" \/>\n<\/div>\n<p><label> Your name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-400\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-400\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"jamie.corbett@tankww.com\">jamie.corbett@tankww.com<\/option><option value=\"stephanie.granowicz@tankww.com\">stephanie.granowicz@tankww.com<\/option><option value=\"Lea Monaco lmonaco@tank.ca\">Lea Monaco lmonaco@tank.ca<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Is this a new submission:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-255\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-255\"><option value=\"New\">New<\/option><option value=\"Follow-up\">Follow-up<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> If this is a follow-up, please enter original file number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-359\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textarea-359\" \/><\/span> <\/label>\n<\/p>\n<p><label>What date was this report posted<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"report-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"2018-10-05\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"report-date\" \/><\/span> <\/label>\n<\/p>\n<p><label>What time was this report posted (HH:MM 24 hour format)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"report-time\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"report-time\" \/><\/span> <\/label>\n<\/p>\n<p><label> Upload Screenshot<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-361\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" accept=\"audio\/*,video\/*,image\/*\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" name=\"file-361\" \/><\/span> <\/label>\n<\/p>\n<p><label> Upload Screenshot<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-362\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"file-362\" \/><\/span> <\/label>\n<\/p>\n<p><label> Upload Screenshot<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-363\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"file-363\" \/><\/span> <\/label>\n<\/p>\n<p><label> Upload Screenshot<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-364\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"file-364\" \/><\/span> <\/label>\n<\/p>\n<p><label> Submitter's name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-276\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-276\" \/><\/span><\/label>\n<\/p>\n<p><label> What is the Gender of the patient:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-245\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-245\"><option value=\"Unknown\">Unknown<\/option><option value=\"Male\">Male<\/option><option value=\"Female\">Female<\/option><option value=\"Both\">Both<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Full product description<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-356\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textarea-356\" \/><\/span> <\/label>\n<\/p>\n<p><label> Product Indication<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-357\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textarea-357\" \/><\/span> <\/label>\n<\/p>\n<p><label> Reporter<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-915\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-915\"><option value=\"Consumer\">Consumer<\/option><option value=\"Doctor\">Doctor<\/option><option value=\"Nurse\">Nurse<\/option><option value=\"Pharmacist\">Pharmacist<\/option><option value=\"Other\">Other<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label> What country does the reporter live in:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-997\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"Canada\" type=\"text\" name=\"text-997\" \/><\/span> <\/label>\n<\/p>\n<p><label> Did the reporter consider the event was possibly related to the product use:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-335\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-335\"><option value=\"Unknown\">Unknown<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> If provided, please enter Patient HCP contact details bellow, if available:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-258\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-258\">NA<\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Information about the patient (person) or groups who used the product, if available:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-259\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-259\">NA<\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Was this an individual or multiple users<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-246\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-246\"><option value=\"Individual\">Individual<\/option><option value=\"Multiple\">Multiple<\/option><option value=\"Unknown\">Unknown<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> What was the age of the user<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-881\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"Unknown\" type=\"text\" name=\"text-881\" \/><\/span><\/label>\n<\/p>\n<p><label> Was the patient pregnant when using the product<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-508\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-508\"><option value=\"Unknown\">Unknown<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label>Other Comment?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-623\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"text-623\">None.<\/textarea><\/span><\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/report.tank.ca\/index.php\/wp-json\/wp\/v2\/pages\/35"}],"collection":[{"href":"https:\/\/report.tank.ca\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/report.tank.ca\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/report.tank.ca\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/report.tank.ca\/index.php\/wp-json\/wp\/v2\/comments?post=35"}],"version-history":[{"count":2,"href":"https:\/\/report.tank.ca\/index.php\/wp-json\/wp\/v2\/pages\/35\/revisions"}],"predecessor-version":[{"id":37,"href":"https:\/\/report.tank.ca\/index.php\/wp-json\/wp\/v2\/pages\/35\/revisions\/37"}],"wp:attachment":[{"href":"https:\/\/report.tank.ca\/index.php\/wp-json\/wp\/v2\/media?parent=35"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}