{"id":2801,"date":"2022-03-20T16:55:45","date_gmt":"2022-03-20T16:55:45","guid":{"rendered":"https:\/\/www.truthforhealth.org\/?page_id=2801"},"modified":"2024-08-06T00:20:29","modified_gmt":"2024-08-06T00:20:29","slug":"vaccine-injury-report","status":"publish","type":"page","link":"https:\/\/www.truthforhealth.org\/es\/vaccine-injury-report\/","title":{"rendered":"VaccineDamage &#8211; Vaccine Injury Report"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Vaccine Damage Reporting System<\/h2>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume\" id=\"wpforms-8849\"><form id=\"wpforms-form-8849\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"8849\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/2801\" data-token=\"a320ed3a511a2cf78001070a35f7ee85\" data-token-time=\"1791921596\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-8849-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"1\"><label class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-8849-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" required><label for=\"wpforms-8849-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-8849-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" required><label for=\"wpforms-8849-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-8849-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-8849-field_2\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-8849-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-8849-field_3-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-8849-field_3\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-8849-field_3\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" aria-label=\"Phone\" required><\/div><div id=\"wpforms-8849-field_23-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-8849-field_23\">City &amp; State where vaccine administered <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-8849-field_23\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][23][first]\" placeholder=\"City\" required><label for=\"wpforms-8849-field_23\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-8849-field_23-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][23][last]\" placeholder=\"State\" required><label for=\"wpforms-8849-field_23-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-8849-field_9-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"9\"><div id=\"wpforms-8849-field_9\"><tr>\r\n<td style='height: 25px;'><\/td>\r\n<\/tr><\/div><\/div><div id=\"wpforms-8849-field_8-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"8\"><label class=\"wpforms-field-label\">May our Truth for Health Foundation team contact you about your vaccine injury? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-8849-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8849-field_8_1\" name=\"wpforms[fields][8][]\" value=\"Yes, Truth for Health Foundation may contact me about my vaccine injury.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8849-field_8_1\">Yes, Truth for Health Foundation may contact me about my vaccine injury.<\/label><\/li><\/ul><\/div><div id=\"wpforms-8849-field_10-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"10\"><div id=\"wpforms-8849-field_10\"><tr>\r\n<td style='height: 25px;'><\/td>\r\n<\/tr><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"8849\"><input type=\"hidden\" name=\"wpforms[time_token]\" value=\"1791921596.88414fbea8abb41e5a6b9ba36cb2d300bbff023b04ccc2e1562042a3102b952c\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.truthforhealth.org\/es\/wp-json\/wp\/v2\/pages\/2801\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-8849\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" 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