Generative models are popular for medical imaging tasks such as anomaly detection, feature extraction, data visualization, or image generation. Since they are parameterized by deep learning models, they are often sensitive to distribution shifts and unreliable when applied to out-of-distribution data, creating a risk of, e.g. underrepresentation bias. This behavior can be flagged using uncertainty quantification methods for generative models, but their availability remains limited. We propose SLUG: A new UQ method for VAEs that combines recent advances in Laplace approximations with stochastic trace estimators to scale gracefully with image dimensionality. We show that our UQ score -- unlike the VAE's encoder variances -- correlates strongly with reconstruction error and racial underrepresentation bias for dermatological images. We also show how pixel-wise uncertainty can detect out-of-distribution image content such as ink, rulers, and patches, which is known to induce learning shortcuts in predictive models.