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Donor and patient safety is our #1 priority

Report of Illness / Report of Travel after Donation

in order to help ensure that the donation process and blood products are safe, it is critical that Blood Donors inform us of any post-donation illness or travel. If you feel sick or recall that you may have traveled to a Malaria infected area after your donation, please complete the following form.

Report of illness/travel after donation

MM slash DD slash YYYY

SICK/ NOT FEELING WELL

If you got sick within 48 hours after your donation, please click on all the symptoms which apply.(Required)
MM slash DD slash YYYY

Cancer

MM slash DD slash YYYY
MM slash DD slash YYYY

MALARIA

MM slash DD slash YYYY
Current/Former Resident of Risk Area
Malarial Meds Taken
Have you developed any signs/symptoms of Malarial?

OTHER

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