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What's happening is there's a long-standing bug in the web page. Instead of taking the web page's input fields, it takes a cookie created by a previous report submission. Maybe find & delete the cookie or use a different browser, a different login, or a different computer.
Actually, that had always irritated me as well so we stopped creating cookies on new problem reports a while ago (apparently May 29th). What I failed to do, however, was to stop
requesting cookies. Those are some old cookies, I wouldn't eat them.
Thanks for pointing it out. Should be fixed now.