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User Feedback Form
Use this form to report product defects or operational defects affecting any product selected from the PQS catalogue or website.
Please complete all fields marked *. If you cannot complete any of the other fields, enter ‘not known’.
A. All respondents should complete section A.
Date *
Insert Date
Inser valid date
Product type *
Select
E001
E002
E003
E004
E005
E006
E007
E008
E009
E010
E011
E012
E013
E014
V500
Select product type
Company *
Insert Company
Model Number *
Insert Model Number
Year of Purchase *
Select
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
Select Year of Purchase
Country *
Select
Abkhazia
Afghanistan
Aland
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Ascension
Ashmore and Cartier Islands
Australia
Australian Antarctic Territory
Austria
Azerbaijan
Bahamas; The
Bahrain
Baker Island
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Antarctic Territory
British Indian Ocean Territory
British Sovereign Base Areas
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China; People's Republic of
China; Republic of (Taiwan)
Christmas Island
Clipperton Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo; Democratic Republic of the (Congo - Kinshasa)
Congo; Republic of the (Congo - Brazzaville)
Cook Islands
Coral Sea Islands
Costa Rica
Cote d'Ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Islas Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia; The
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Howland Island
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jarvis Island
Jersey
Johnston Atoll
Jordan
Kazakhstan
Kenya
Kingman Reef
Kiribati
Korea; Democratic People's Republic of (North Korea)
Korea; Republic of (South Korea)
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Midway Islands
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Nagorno-Karabakh
Namibia
Nauru
Navassa Island
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Cyprus
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territories (Gaza Strip and West Bank)
Palmyra Atoll
Panama
Papua New Guinea
Paraguay
Peru
Peter I Island
Philippines
Pitcairn Islands
Poland
Portugal
Pridnestrovie (Transnistria)
Puerto Rico
Qatar
Queen Maud Land
Reunion
Romania
Ross Dependency
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Georgia and the South Sandwich Islands
South Ossetia
Spain
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Thailand
Timor-Leste (East Timor)
Togo
Tokelau
Tonga
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wake Island
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Select country
Province/region *
Insert province/region
Type of facility *
Insert Type of facility
Describe the problem *
Insert problem description
How many units are affected by this problem? *
Insert Unit Number
Is the company’s warranty still current for any affected units?
If yes, has the supplier (including UNICEF-SD) been contacted?
What other action has been taken to resolve the problem?
Do you have suggestions for improving this product?
If possible, insert a digital picture here to illustrate the problem. Use .jpg format.
B. If you are a WHO or UNICEF staff member or consultant, please complete section B. Other respondents should only complete this section if they wish to do so.
Respondent’s name
Organization
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Source of data
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Personal inspection
Report received
Vaccine management assessment
EVSM assessment
Other (please specify)
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