Medical Information Request Form – Healthcare Professional

This page is intended for Healthcare Professionals and other relevant decision makers in Poland.

This form is NOT intended to report Adverse Events and/or report Product Quality Complaints. 

Please fill out the form below with your information and question and a member of our team will be in touch.

Inquiry Form

Your Contact Information

All fields marked with an asterisk (*) are required.
Phone Number

Phone number is required in the event additional information is needed to clarify your question.

Preferred Response
Fax Number
Healthcare Professional Type

Your Enquiry

If you have questions regarding multiple Novavax products, please complete a separate Medical Information Request Form for each Novavax product.

Please do not provide any personal information within this field that could identify an individual.

By submitting this form, you agree that this enquiry is unsolicited and that you are a Healthcare Professional.

Novavax respects and recognises your privacy. The information you provide will be used to process your medical information request. In compliance with the Sunshine Act, when a US licensed physician requests a journal article, the value of the article, along with shipping costs if mailed, may be subject to reporting. This information may be shared with affiliates and partners. Your information will be treated in accordance with Novavax’s Privacy Policy.

You may also

Report an Adverse Event (AE)

If you are concerned about an adverse event, it should be reported to the Office for Medicinal Products, Medical Devices and Biocides at http://www.urpl.gov.pl.

Alternatively, adverse events of concern in association with a Novavax product can be reported to Novavax Pharmacovigilance at +48 22 104 74 91 or via the Novavax Adverse Event Reporting Form.