Share Your Story

Would you like to share your own experiences to help others avoid a reaction in a similar situation? Please fill in the form below.

Reaction Registry

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How old were you when you had the reaction?*:

What allergen was the reaction to?*:

PeanutTree NutEggShellfishFishMilkSoySesameWheatPenicillinUnknownOther

...if Other, what was the allergen?:

What symptom(s) did you experience?*:

Where were you when it happened?*:

High SchoolCollege / UniversityRestaurantHomeFriend / Relative HouseDuring TravelWorkplaceOther

...if Other, where were you?:

What's the story?*:

How could this have been prevented? / What would you recommend to others?*:

Verification:

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Answer

After submission, your entry will be sent to Anaphylaxis Canada for web editing purposes before being displayed on the Reaction Registry.

Please note that no submission deemed inappropriate or offensive will be posted on the registry.

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