While your Application is under review, the Administrator may ask for additional documents to be provided in connection with your Application. Depending on the situation, the Administrator may ask you, or the Registered Health Professional(s) who completed your Supporting Evidence Form, or other persons or bodies, for those additional documents.

The additional documents requested by the Administrator should be submitted within 90 days from the date of the Administrator’s request.

Note the review process involving your Application will be suspended pending the Administrator’s receipt of the additional documents requested in respect of your Application.

Submit Additional Documents Online

To submit additional documents online, please:

  1. Obtain and scan the additional documents requested by the Administrator.
  2. Upload and submit the additional documents on Upload Documents.

Note: submitting additional documents online requires input of Applicant’s name and the Application number.

Submit Additional Documents by Email

To submit additional documents by email, please:

  1. Obtain and scan the additional documents requested by the Administrator.
  2. Email these scanned forms and documents (as one or more email attachments) to [email protected].

Submit Additional Documents by Regular Mail

To submit additional documents by regular mail, please:

  1. Obtain the additional documents requested by the Administrator.
  2. Send these scanned forms and documents by regular mail to one of the Program’s Regional Centers.
Application

A written claim for compensation completed by an Applicant on the application form approved by and provided by the Administrator, as set forth in Schedule 2 to the Program's Protocol, which must be accompanied by all Supporting Evidence, using the prescribed form in Schedule 3 to the Program’s Protocol.

Administrator

ESIS, Inc., the claims Administrator appointed to manage and administer the Program, including, but not limited to, the receipt and registration of Applications, distributing acknowledgements of receipt of Applications, setting financial reserves for Receivable Claims, review of Applications, Supporting Evidence, and other documents to assess receivability, assessing Receivable Claims, and approve or deny, as the case may be, Payment for compensation, in accordance with the terms of the Program's Protocol.

Registered Health Professional

Any healthcare professional, including physicians, surgeons, nurses, midwives, nurse practitioners, physicians’ assistants, psychiatrists, psychiatrists, physical therapists, occupational therapists, dentists, and pharmacists, who is duly licensed or legally authorized to practice the profession in the Participating Member State in which the Patient resides and received the Vaccine, or in the case of birth defects, where the Patient’s mother resides and received the Vaccine.

Supporting Evidence

The supporting evidence, using the form in Schedule 3 to the Program's Protocol, required to evaluate an Application and that shall include:

  1. detailed medical documentation from a Registered Health Professional describing the Injury and medical treatment required as a result of the Injury, together with details of any Hospitalization or prolonged Hospitalization, including but not limited to admission and discharge records;
  2. a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Health Professional.
  3. a statement from the Registered Health Professional that the Injury was, in the Registered Health Professional’s opinion, the result of the Vaccine or its administration;
  4. certification from a Registered Health Professional of when, where and which Vaccine was administered;
  5. in the case of death, a death certificate and any other documentation available from a Registered Health Professional of the cause and manner of death; and
  6. any further evidence that the Administrator may deem necessary to adjudicate the Application, and/or Receivable Claim, as applicable, guided, as appropriate, by the Scientific Advisory Committee, the Review Panel, and/or the Appeals Panel.
Applicant

Either (as the context requires):

  1. The Patient who directly submits an Application for compensation under the Program for himself; or
  2. In the event the Patient has died, is a child, or is disabled or otherwise lacks the legal capacity to submit an Application for himself, then the Applicant must be a person who is a duly authorized legal heir (in the case of death), parent, legal guardian, or other legal representative of the Patient.