Submit a Case

When you submit a case, you help us gain a deeper understanding into individual cases of AFE and allow us the ability to gather vital information on the efficacy of treatments, reproductive and long-term health of survivors of AFE. The data also serves as a basis for clinical research. To date, this registry has resulted in 13 publications that describe the clinical findings of typical and atypical forms of AFE, reproductive decisions, recurrence, and proposed diagnostic criteria for AFE.

Please complete the form below. No patient identifying information is required for its completion. Once the form is submitted, you will receive a follow up email or call from a research coordinator to provide the next step. We will work with you to consent the patient or their legally authorized representative.