Have you experienced side effects after getting vaccinated? Tell your story here. First Name *Last Name *Email *Nationality *Date of Birth *2125212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619250102030405060708091011120102030405060708091011121314151617181920212223242526272829303132Race *American IndianAsianBlackHispanicNative HawaiianWhiteOtherSex *FemaleMaleDate of Vaccination *Reason For Vaccination Took one for the team, voluntaryEmployer mandateMilitary mandatePrison mandateOther reasonWhere did you get Vaccinated? *Facility Website URL Vaccine Type *COVID19 AstraZenecaCOVID19 JanssenCOVID19 ModeRNACOVID19 Pfizer-BioNTechHPV Gardasil 9OtherIf "Other" List Vaccine Type Vaccine Injury Severity *Life threatening reactionDisability or permanent damageMedical care was requiredPain or discomfortVaccine Injury Type *Cardiac Harm (myocarditis)Birth DefectImmune ResponseNeurological HarmPost Injection PainReproductive HarmSudden Termintion of PregnancyOtherAdditional Information MessageSubmit
