Become a HYMPAVZI^® (marstacimab-hncq) Ambassador

Patient Ambassador

Become a Patient Ambassador to help other people with hemophilia A or B, with or without inhibitors. Learn about HYMPAVZI. Hearing about your experience with HYMPAVZI may be helpful for patients who are considering treatment or have already started treatment. If you're selected, your story may appear on HYMPAVZI.com and/or in other marketing materials.

You may also be invited to participate in various public relations, marketing, and/or promotional activities on behalf of Pfizer. By giving Pfizer your phone number and email address, you are giving us permission to contact you regarding the Patient Ambassador Program. Please note that patients may also be required to provide additional medical information and sign consent forms.

Eligibility Criteria

In order to submit your story, you must:

• Be 18 years or older
• Have been diagnosed with hemophilia A or B, with or without inhibitors
• Be currently taking HYMPAVZI
• Not be enrolled in a current Pfizer clinical trial
• Be a resident of the United States

Consent to Collect, Use and Disclose Health Information

Pfizer Inc. (“Pfizer”) will collect certain personal health information (described below) about me so that it may share my personal story about HYMPAVZI. Pfizer is seeking this consent because it needs to collect, use and disclose such information, which may be considered sensitive information, in connection with my story. I am interested in sharing my story as a Patient Ambassador and am voluntarily providing my health information.

Health Information Collected. The personal health information Pfizer and its service providers collect includes name, test results, medical records, healthcare provider information, other data that identifies that you are seeking healthcare services, and data otherwise related to your health condition, diagnosis, and/or treatment (collectively “Health Information”).

Purposes of Collection and Use. Your Health Information will be used for the following purposes:

• To share your personal story about your experience using HYMPAVZI for the treatment of hemophilia A or B, with or without inhibitors

Duration. I permit such use of my Health Information for two years after the date I sign this consent, unless and until I revoke (i.e., take back) it in writing prior to that time.

Revocation. I may revoke this consent at any time, except to the extent that Pfizer has taken any action in reliance on my consent. I understand that if I revoke this consent, it will not have any effect on any use of my Health Information that occurred prior to receiving my revocation or to any Health Information that Pfizer has a legal obligation to maintain. I understand that this consent to collect, use and disclose my Health Information is voluntary and may be revoked in writing at any time. To revoke, I understand that I must notify Pfizer in writing at the following email: myhympavzistory@mypatientstory.com

I have read this consent and/or had its contents read to me. I fully understand the terms and conditions described above.

• Be 18 years or older
• Have been diagnosed with hemophilia A or B, with or without inhibitors
• Be currently taking HYMPAVZI
• Not be enrolled in a current Pfizer clinical trial
• Be a resident of the United States

By checking this box, I am signing this consent on my own free will and I agree to the collection, use and disclosure of my Health Information as described above. I certify that all information I submitted is true and accurate and that I am at least eighteen (18) years of age and live in the United States. I understand that a signed copy of this consent is available to me upon request.