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Would you like to meet with a federal agency regarding a vaccine that you are developing? If you submit some basic
information on that product, we will evaluate your request and route it to the most appropriate resource within the
federal government. In some instances, it is not necessary or appropriate for a federal agency representative to meet
with companies regarding their products. In the event that a federal agency representative is unable to meet with you,
we will provide you with that information in a timely manner.
All submissions to MedicalCountermeasures.gov are voluntary and are for information only. However, the submission
of complete information may facilitate the routing of your request. It is important that we route your request to the most
appropriate federal entity. By selecting all federal entities listed below, you increase the probability that we will be able
to route your request appropriately. However, selecting all of the federal entities above does not guarantee that it is
appropriate for the federal government to meet with you at this time.
A field with an asterisk (*) before it is a required field
Requestor Phone

-

-

Company URL
Product Name
Specific Threat Agent (choose Check All
all that apply)
c Anthrax (Bacillus anthracis)
d
e
f
g

Uncheck All

c Botulism (Clostridium botulinum
d
e
f
g
toxin)
c Brucellosis (Brucella species)
d
e
f
g

c Ricin Toxin from Ricinus communis
d
e
f
g
(castor beans)
c Smallpox (variola major)
d
e
f
g

c Epsilon Toxin of Clostridium
d
e
f
g
perfringens

c Staphylococcal enterotoxin B
d
e
f
g

c Food Safety Threats (e.g.,
d
e
f
g
Salmonella species, Escherichia coli
O157:H7, Shigella)

c Tularemia (Francisella tularensis)
d
e
f
g

c Glanders (Burkholderia mallei)
d
e
f
g

http://hhsdev.dyonyx.com/Restricted/Vaccines.aspx

c Q Fever (Coxiella burnetti)
d
e
f
g

c Typhus fever (Rickettsia prowazekii)
d
e
f
g

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MedicalCounterMeasures.gov

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c Meliodosis (Burkholderia
d
e
f
g
pseudomallei)
c Influenza
d
e
f
g
g Plague (Yersinia pestis)
c
d
e
f

c Viral hemorrhagic fevers (filoviruses
d
e
f
g
and arenaviruses)
c Water Safety Threats (e.g., Vibrio
d
e
f
g
cholerae, Cryptosporidium parvum)
g Other (Please Specify)
c
d
e
f

c Psittacosis (Chlamydia psittaci)
d
e
f
g

Technology Readiness Level

Technology Readiness Level Descriptions
Uncheck All

Route of Administration Check All
c Intravenous
d
e
f
g

c Oral
d
e
f
g

g Intramuscular Injection
c
d
e
f

g Subcutaneous
c
d
e
f

c “Needle-Free” Injection
d
e
f
g

c Transdermal
d
e
f
g

g Intranasal
c
d
e
f

g Other (Please Specify)
c
d
e
f

Indications for Use (check all Check All
that apply) g
c Pre-Exposure Prophylaxis
d
e
f

Uncheck All
c Other (Please Specify)
d
e
f
g

c Post-Exposure Prophylaxis
d
e
f
g

Number of Doses Required for
Efficacy or per Regimen
Anticipated Product Stability Years

Months

Temperature at which product is
stable (please indicate range)
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*Does your submission include n
j No n
k
l
m
j Yes
k
l
m
proprietary, confidential, or
trade secret information?
Please select those federal Check All
entities that you would be
b HHS/BARDA
c
d
e
f
g
interested in potentially meeting

http://hhsdev.dyonyx.com/Restricted/Vaccines.aspx

Uncheck All
b HHS/FDA
c
d
e
f
g

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MedicalCounterMeasures.gov

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with. Please do not select an g
b HHS/CDC
c
d
e
f
entity in which you are currently
competing for a contract under
as active solicitation issued in
accordance with the Federal
Acquisition Regulation.
Comments

b HHS/NIH
c
d
e
f
g

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9/26/2007