Influenza Vaccine Availability Tracking System: Reporting Form

This form is for use by distributors or manufacturers of seasonal influenza vaccines. Your voluntary participation helps provide a valuable resource to healthcare providers who need to determine which wholesale distributors or manufacturers have seasonal influenza vaccine for sale. The information about the availability of influenza vaccine will be incorporated into a spreadsheet that will be posted on the Summit’s website and available for healthcare providers to view.

Complete the form below, then click the “submit” button.