{"id":3079,"date":"2022-04-08T17:26:34","date_gmt":"2022-04-08T17:26:34","guid":{"rendered":"https:\/\/www.truthforhealth.org\/?page_id=3079"},"modified":"2022-04-08T17:33:20","modified_gmt":"2022-04-08T17:33:20","slug":"informe-de-lesiones-por-vacunas","status":"publish","type":"page","link":"https:\/\/www.truthforhealth.org\/es\/informe-de-lesiones-por-vacunas\/","title":{"rendered":"Informe de lesiones por Vacunas"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"> Citizens&#8217; Vaccine Injury Reporting System<\/h2>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume\" id=\"wpforms-2981\"><form id=\"wpforms-form-2981\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"2981\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/3079\" data-token=\"f1e1ef4775559772d37c822574aa5b30\" data-token-time=\"1791276202\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-2981-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"1\"><label class=\"wpforms-field-label wpforms-label-hide\">Nombre <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-2981-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" placeholder=\"Nombre\" required><label for=\"wpforms-2981-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2981-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" placeholder=\"Apellido\" required><label for=\"wpforms-2981-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-2981-field_2-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_2\">Fecha<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2981-field_2\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][2][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2981-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_3\">Edad<\/label><input type=\"number\" id=\"wpforms-2981-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" step=\"any\" ><\/div><div id=\"wpforms-2981-field_4-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_4\">Fecha de Nacimiento<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2981-field_4\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][4][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2981-field_6-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_6\">Genero<\/label><select id=\"wpforms-2981-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Seleccione la respuesta<\/option><option value=\"MASCULINO\"  class=\"choice-1 depth-1\"  >MASCULINO<\/option><option value=\"FEMENINO\"  class=\"choice-2 depth-1\"  >FEMENINO<\/option><\/select><\/div><div id=\"wpforms-2981-field_7-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_7\">Correo Electr\u00f3nico <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-2981-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-2981-field_8-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_8\">N\u00famero de contacto principal<\/label><input type=\"tel\" id=\"wpforms-2981-field_8\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][8]\" aria-label=\"N\u00famero de contacto principal\" ><\/div><div id=\"wpforms-2981-field_41-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_41\">Es el demandante el mismo que el lesionado<\/label><select id=\"wpforms-2981-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Seleccione la respuesta<\/option><option value=\"SI\"  class=\"choice-1 depth-1\"  >SI<\/option><option value=\"NO\"  class=\"choice-2 depth-1\"  >NO<\/option><\/select><\/div><div id=\"wpforms-2981-field_42-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_42\">Si no lo es, por favor complete su nombre e informaci\u00f3n de contacto<\/label><textarea id=\"wpforms-2981-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\" ><\/textarea><\/div><div id=\"wpforms-2981-field_68-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_68\">\u00bfLe confirmaron que tuvo COVID antes que le pusieran inyecci\u00f3n?<\/label><select id=\"wpforms-2981-field_68\" class=\"wpforms-field-medium\" name=\"wpforms[fields][68]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Seleccione la respuesta<\/option><option value=\"SI\"  class=\"choice-1 depth-1\"  >SI<\/option><option value=\"NO\"  class=\"choice-2 depth-1\"  >NO<\/option><\/select><\/div><div id=\"wpforms-2981-field_69-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_69\">\u00bfSospecha que tuvo COVID?<\/label><select id=\"wpforms-2981-field_69\" class=\"wpforms-field-medium\" name=\"wpforms[fields][69]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Seleccione la respuesta<\/option><option value=\"SI\"  class=\"choice-1 depth-1\"  >SI<\/option><option value=\"NO\"  class=\"choice-2 depth-1\"  >NO<\/option><\/select><\/div><div id=\"wpforms-2981-field_70-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_70\">\u00bfTuvo COVID despu\u00e9s que le hayan puesto la inyecci\u00f3n?<\/label><select id=\"wpforms-2981-field_70\" class=\"wpforms-field-medium\" name=\"wpforms[fields][70]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Seleccione la respuesta<\/option><option value=\"SI\"  class=\"choice-1 depth-1\"  >SI<\/option><option value=\"NO\"  class=\"choice-2 depth-1\"  >NO<\/option><\/select><\/div><div id=\"wpforms-2981-field_43-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_43\">Raz\u00f3n por ponerse la vacuna<\/label><select id=\"wpforms-2981-field_43\" class=\"wpforms-field-medium\" name=\"wpforms[fields][43]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Seleccione la respuesta<\/option><option value=\"Mandato del Empleador\"  class=\"choice-1 depth-1\"  >Mandato del Empleador<\/option><option value=\"Mandato Militar\"  class=\"choice-2 depth-1\"  >Mandato Militar<\/option><option value=\"Deseo de prevenir la infecci\u00f3n\"  class=\"choice-3 depth-1\"  >Deseo de prevenir la infecci\u00f3n<\/option><option value=\"Deseo de proteger a otros\"  class=\"choice-4 depth-1\"  >Deseo de proteger a otros<\/option><option value=\"Viaje\"  class=\"choice-5 depth-1\"  >Viaje<\/option><option value=\"Presi\u00f3n familiar \"  class=\"choice-6 depth-1\"  >Presi\u00f3n familiar<\/option><option value=\"Presi\u00f3n social\"  class=\"choice-7 depth-1\"  >Presi\u00f3n social<\/option><option value=\"Requisito de la Universidad\/Colegio\"  class=\"choice-9 depth-1\"  >Requisito de la Universidad\/Colegio<\/option><option value=\"Requisito de casa de asilo de ancianos\"  class=\"choice-10 depth-1\"  >Requisito de casa de asilo de ancianos<\/option><option value=\"Requisito del centro de vida asistida\"  class=\"choice-11 depth-1\"  >Requisito del centro de vida asistida<\/option><option value=\"Requisito de la comunidad de jubilados\"  class=\"choice-12 depth-1\"  >Requisito de la comunidad de jubilados<\/option><option value=\"Otra\"  class=\"choice-8 depth-1\"  >Otra<\/option><\/select><\/div><div id=\"wpforms-2981-field_44-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_44\">Si es otra, incluya la(s) raz\u00f3n(es)<\/label><input type=\"text\" id=\"wpforms-2981-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" ><\/div><div id=\"wpforms-2981-field_45-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"45\"><label class=\"wpforms-field-label\">Cual(es) vacuna(s) de COVID recibi\u00f3?<\/label><ul id=\"wpforms-2981-field_45\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_45_1\" name=\"wpforms[fields][45][]\" value=\"Pfizer\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_45_1\">Pfizer<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_45_2\" name=\"wpforms[fields][45][]\" value=\"Moderna\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_45_2\">Moderna<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_45_3\" name=\"wpforms[fields][45][]\" value=\"Johnson &amp; Johnson\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_45_3\">Johnson &amp; Johnson<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_45_4\" name=\"wpforms[fields][45][]\" value=\"Astra Zeneca\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_45_4\">Astra Zeneca<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_45_5\" name=\"wpforms[fields][45][]\" value=\"Sinovac\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_45_5\">Sinovac<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_46-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_46\">Fecha de la primera vacuna (si sabe)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2981-field_46\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][46][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2981-field_47-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_47\">Fecha de la segunda vacuna(si sabe)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2981-field_47\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][47][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2981-field_48-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_48\">Fecha de la tercera vacuna (si sabe)<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2981-field_48\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][48][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2981-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_49\">Primera Vacuna - N\u00famero de Identificaci\u00f3n del lote<\/label><input type=\"text\" id=\"wpforms-2981-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" ><\/div><div id=\"wpforms-2981-field_50-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_50\">Segunda Vacuna - N\u00famero de Identificaci\u00f3n del lote<\/label><input type=\"text\" id=\"wpforms-2981-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" ><\/div><div id=\"wpforms-2981-field_51-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_51\">Tercera Vacuan - N\u00famero de Identificaci\u00f3n del lote<\/label><input type=\"text\" id=\"wpforms-2981-field_51\" class=\"wpforms-field-medium\" name=\"wpforms[fields][51]\" ><\/div><div id=\"wpforms-2981-field_12-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_12\">Cuando comenz\u00f3 su evento adverso o s\u00edntomas adversos?<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2981-field_12\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][12][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2981-field_52-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"52\"><label class=\"wpforms-field-label\">Resultado del evento adverso o s\u00edntomas (marque todo lo que corresponda)<\/label><ul id=\"wpforms-2981-field_52\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_52_1\" name=\"wpforms[fields][52][]\" value=\" Visita al doctor o consulta con otro profesional de la salud\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_52_1\">Visita al doctor o consulta con otro profesional de la salud<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_52_2\" name=\"wpforms[fields][52][]\" value=\"Visita a la sala de emergencia o centro de cuidado de urgencia\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_52_2\">Visita a la sala de emergencia o centro de cuidado de urgencia<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_52_3\" name=\"wpforms[fields][52][]\" value=\"Hospitalizaci\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_52_3\">Hospitalizaci\u00f3n<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_52_4\" name=\"wpforms[fields][52][]\" value=\"Hospitalizaci\u00f3n prolongada (Vacuna de COVID recibida en el hospital)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_52_4\">Hospitalizaci\u00f3n prolongada (Vacuna de COVID recibida en el hospital)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_52_5\" name=\"wpforms[fields][52][]\" value=\"Enfermedad que amenaza la vida\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_52_5\">Enfermedad que amenaza la vida<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_52_6\" name=\"wpforms[fields][52][]\" value=\"Descapacidad o da\u00f1o permanente\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_52_6\">Descapacidad o da\u00f1o permanente<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_52_7\" name=\"wpforms[fields][52][]\" value=\"El paciente falleci\u00f3\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_52_7\">El paciente falleci\u00f3<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_52_8\" name=\"wpforms[fields][52][]\" value=\"Anomal\u00eda cong\u00e9nita o defecto de nacimiento\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_52_8\">Anomal\u00eda cong\u00e9nita o defecto de nacimiento<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_52_9\" name=\"wpforms[fields][52][]\" value=\"Aborto espont\u00e1neo o nacimiento muerto\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_52_9\">Aborto espont\u00e1neo o nacimiento muerto<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_52_10\" name=\"wpforms[fields][52][]\" value=\"Ninguna de las anteriores\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_52_10\">Ninguna de las anteriores<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_14-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_14\">\u00bfSiguen present\u00e1ndose los s\u00edntomas?<\/label><select id=\"wpforms-2981-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Seleccione la respuesta<\/option><option value=\"S\u00ed\"  class=\"choice-1 depth-1\"  >S\u00ed<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><\/select><\/div><div id=\"wpforms-2981-field_53-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"53\"><label class=\"wpforms-field-label\">Alergias conocidas a<\/label><ul id=\"wpforms-2981-field_53\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_53_1\" name=\"wpforms[fields][53][]\" value=\"Medicamentos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_53_1\">Medicamentos<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_53_2\" name=\"wpforms[fields][53][]\" value=\"Polietilen-glicol\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_53_2\">Polietilen-glicol<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_53_3\" name=\"wpforms[fields][53][]\" value=\"Comida\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_53_3\">Comida<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_53_4\" name=\"wpforms[fields][53][]\" value=\"Ambiente\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_53_4\">Ambiente<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_53_5\" name=\"wpforms[fields][53][]\" value=\"Otra\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_53_5\">Otra<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_54-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_54\">Descripci\u00f3n de alergias conocidas<\/label><textarea id=\"wpforms-2981-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" ><\/textarea><\/div><div id=\"wpforms-2981-field_55-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_55\">Ocupaci\u00f3n<\/label><input type=\"text\" id=\"wpforms-2981-field_55\" class=\"wpforms-field-medium\" name=\"wpforms[fields][55]\" ><\/div><div id=\"wpforms-2981-field_56-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_56\">Antecedentes raciales<\/label><select id=\"wpforms-2981-field_56\" class=\"wpforms-field-medium\" name=\"wpforms[fields][56]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Seleccione la respuesta<\/option><option value=\"Afroamericano(a)\"  class=\"choice-1 depth-1\"  >Afroamericano(a)<\/option><option value=\"Hispano(a)\"  class=\"choice-2 depth-1\"  >Hispano(a)<\/option><option value=\"Blanco(a)\"  class=\"choice-3 depth-1\"  >Blanco(a)<\/option><option value=\"Asi\u00e1tic(o)(a)\"  class=\"choice-4 depth-1\"  >Asi\u00e1tic(o)(a)<\/option><option value=\"Nativo(a) Americano(a)\"  class=\"choice-5 depth-1\"  >Nativo(a) Americano(a)<\/option><option value=\"Otro\"  class=\"choice-6 depth-1\"  >Otro<\/option><\/select><\/div><div id=\"wpforms-2981-field_59-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_59\">\u00bfEstaba embarazada cuando se puso la vacuna?<\/label><select id=\"wpforms-2981-field_59\" class=\"wpforms-field-medium\" name=\"wpforms[fields][59]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Seleccione la respuesta<\/option><option value=\"S\u00ed\"  class=\"choice-1 depth-1\"  >S\u00ed<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><\/select><\/div><div id=\"wpforms-2981-field_60-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_60\">\u00bfAlguna vez ha tenido una reacci\u00f3n adversa uan vacuna en el pasado?<\/label><select id=\"wpforms-2981-field_60\" class=\"wpforms-field-medium\" name=\"wpforms[fields][60]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Seleccione la respuesta<\/option><option value=\"S\u00ed\"  class=\"choice-1 depth-1\"  >S\u00ed<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><\/select><\/div><div id=\"wpforms-2981-field_61-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_61\">Si es as\u00ed, especifique<\/label><textarea id=\"wpforms-2981-field_61\" class=\"wpforms-field-medium\" name=\"wpforms[fields][61]\" ><\/textarea><\/div><div id=\"wpforms-2981-field_15-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"15\"><h3 id=\"wpforms-2981-field_15\">Condiciones m\u00e9dicas: Desde su vacuna COVID, COMIENZO DE UNA NUEVA CONDICION (marque todas las que correspondan)<\/h3><\/div><div id=\"wpforms-2981-field_17-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"17\"><label class=\"wpforms-field-label wpforms-label-hide\">New Onset Conditions<\/label><ul id=\"wpforms-2981-field_17\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_1\" name=\"wpforms[fields][17][]\" value=\"La enfermedad de Addison\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_1\">La enfermedad de Addison<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_2\" name=\"wpforms[fields][17][]\" value=\"Alergias\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_2\">Alergias<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_3\" name=\"wpforms[fields][17][]\" value=\"Arritmias o trastorno del ritmo cardiaco\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_3\">Arritmias o trastorno del ritmo cardiaco<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_4\" name=\"wpforms[fields][17][]\" value=\"Febrilaci\u00f3n Auricular\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_4\">Febrilaci\u00f3n Auricular<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_5\" name=\"wpforms[fields][17][]\" value=\"Vasculitis Autoimmuno\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_5\">Vasculitis Autoimmuno<\/label><\/li><li class=\"choice-46 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_46\" name=\"wpforms[fields][17][]\" value=\"Par\u00e1lisis de Bell (par\u00e1lisis facial)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_46\">Par\u00e1lisis de Bell (par\u00e1lisis facial)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_6\" name=\"wpforms[fields][17][]\" value=\"Bronquitis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_6\">Bronquitis<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_7\" name=\"wpforms[fields][17][]\" value=\"Cancer\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_7\">Cancer<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_8\" name=\"wpforms[fields][17][]\" value=\"Enfermedad cel\u00edaca (intolerancia al gluten)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_8\">Enfermedad cel\u00edaca (intolerancia al gluten)<\/label><\/li><li class=\"choice-36 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_36\" name=\"wpforms[fields][17][]\" value=\"Enfermedad cr\u00f3nica renal\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_36\">Enfermedad cr\u00f3nica renal<\/label><\/li><li class=\"choice-33 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_33\" name=\"wpforms[fields][17][]\" value=\"Congestive Heart Failure\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_33\">Congestive Heart Failure<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_9\" name=\"wpforms[fields][17][]\" value=\"Enfermedad de Crohn\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_9\">Enfermedad de Crohn<\/label><\/li><li class=\"choice-37 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_37\" name=\"wpforms[fields][17][]\" value=\"Trombosis venosa profunda (Co\u00e1gulos de sangre)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_37\">Trombosis venosa profunda (Co\u00e1gulos de sangre)<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_10\" name=\"wpforms[fields][17][]\" value=\"Diabetes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_10\">Diabetes<\/label><\/li><li class=\"choice-38 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_38\" name=\"wpforms[fields][17][]\" value=\"Encefalitis (inflamaci\u00f3n cerebral\/dolores de cabeza)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_38\">Encefalitis (inflamaci\u00f3n cerebral\/dolores de cabeza)<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_11\" name=\"wpforms[fields][17][]\" value=\"Epilepsia (convulsiones)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_11\">Epilepsia (convulsiones)<\/label><\/li><li class=\"choice-34 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_34\" name=\"wpforms[fields][17][]\" value=\"La Enfermedad al coraz\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_34\">La Enfermedad al coraz\u00f3n<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_12\" name=\"wpforms[fields][17][]\" value=\"Herpes Type 1\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_12\">Herpes Type 1<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_13\" name=\"wpforms[fields][17][]\" value=\"Herpes Type 2\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_13\">Herpes Type 2<\/label><\/li><li class=\"choice-39 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_39\" name=\"wpforms[fields][17][]\" value=\"VIH\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_39\">VIH<\/label><\/li><li class=\"choice-40 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_40\" name=\"wpforms[fields][17][]\" value=\"Hipertension (Presi\u00f3n Sanguinea Elevada)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_40\">Hipertension (Presi\u00f3n Sanguinea Elevada)<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_14\" name=\"wpforms[fields][17][]\" value=\"Enfermedad inflamatoria intestinal\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_14\">Enfermedad inflamatoria intestinal<\/label><\/li><li class=\"choice-41 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_41\" name=\"wpforms[fields][17][]\" value=\"Enfermedad Renal, Aguda\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_41\">Enfermedad Renal, Aguda<\/label><\/li><li class=\"choice-35 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_35\" name=\"wpforms[fields][17][]\" value=\"Enfermedad del Higado\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_35\">Enfermedad del Higado<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_15\" name=\"wpforms[fields][17][]\" value=\"Lupus\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_15\">Lupus<\/label><\/li><li class=\"choice-42 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_42\" name=\"wpforms[fields][17][]\" value=\"Aborto Espont\u00e1neo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_42\">Aborto Espont\u00e1neo<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_16\" name=\"wpforms[fields][17][]\" value=\"Esclerosis m\u00faltiple\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_16\">Esclerosis m\u00faltiple<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_17\" name=\"wpforms[fields][17][]\" value=\"Miastenia gravis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_17\">Miastenia gravis<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_18\" name=\"wpforms[fields][17][]\" value=\"Infarto de miocardio (ataque al coraz\u00f3n)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_18\">Infarto de miocardio (ataque al coraz\u00f3n)<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_19\" name=\"wpforms[fields][17][]\" value=\"Miocarditis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_19\">Miocarditis<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_20\" name=\"wpforms[fields][17][]\" value=\"Osteoartritis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_20\">Osteoartritis<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_21\" name=\"wpforms[fields][17][]\" value=\"Pericarditis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_21\">Pericarditis<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_22\" name=\"wpforms[fields][17][]\" value=\"Anemia perniciosa\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_22\">Anemia perniciosa<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_23\" name=\"wpforms[fields][17][]\" value=\"Neumonia\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_23\">Neumonia<\/label><\/li><li class=\"choice-43 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_43\" name=\"wpforms[fields][17][]\" value=\"Parto prematuro\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_43\">Parto prematuro<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_24\" name=\"wpforms[fields][17][]\" value=\"Soriasis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_24\">Soriasis<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_25\" name=\"wpforms[fields][17][]\" value=\"Artritis psori\u00e1sica\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_25\">Artritis psori\u00e1sica<\/label><\/li><li class=\"choice-44 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_44\" name=\"wpforms[fields][17][]\" value=\"Embolia pulmonar\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_44\">Embolia pulmonar<\/label><\/li><li class=\"choice-26 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_26\" name=\"wpforms[fields][17][]\" value=\"Artritis Reumatoide\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_26\">Artritis Reumatoide<\/label><\/li><li class=\"choice-27 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_27\" name=\"wpforms[fields][17][]\" value=\"Herpes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_27\">Herpes<\/label><\/li><li class=\"choice-28 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_28\" name=\"wpforms[fields][17][]\" value=\"S\u00edndrome de Sjogren\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_28\">S\u00edndrome de Sjogren<\/label><\/li><li class=\"choice-45 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_45\" name=\"wpforms[fields][17][]\" value=\"Parto de mortinato\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_45\">Parto de mortinato<\/label><\/li><li class=\"choice-29 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_29\" name=\"wpforms[fields][17][]\" value=\"Accidente cerebrovascular o Embolia\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_29\">Accidente cerebrovascular o Embolia<\/label><\/li><li class=\"choice-30 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_30\" name=\"wpforms[fields][17][]\" value=\"Ataques isqu\u00e9micos transitorios (AIT)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_30\">Ataques isqu\u00e9micos transitorios (AIT)<\/label><\/li><li class=\"choice-31 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_31\" name=\"wpforms[fields][17][]\" value=\"Trastorno de la tiroides\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_31\">Trastorno de la tiroides<\/label><\/li><li class=\"choice-32 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_17_32\" name=\"wpforms[fields][17][]\" value=\"Colitis ulcerosa\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_17_32\">Colitis ulcerosa<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_18-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"18\"><h3 id=\"wpforms-2981-field_18\">Desde la vacuna contra el COVID, \u00bfha EMPEORADO alguno de los siguientes problemas m\u00e9dicos EXISTENTES?<\/h3><\/div><div id=\"wpforms-2981-field_67-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"67\"><label class=\"wpforms-field-label wpforms-label-hide\">Worsening of Existing Conditions<\/label><ul id=\"wpforms-2981-field_67\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_1\" name=\"wpforms[fields][67][]\" value=\"La enfermedad de Addison\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_1\">La enfermedad de Addison<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_2\" name=\"wpforms[fields][67][]\" value=\"Alergias\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_2\">Alergias<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_3\" name=\"wpforms[fields][67][]\" value=\"Arritmias o trastorno del ritmo cardiaco\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_3\">Arritmias o trastorno del ritmo cardiaco<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_4\" name=\"wpforms[fields][67][]\" value=\"Febrilaci\u00f3n Auricular\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_4\">Febrilaci\u00f3n Auricular<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_5\" name=\"wpforms[fields][67][]\" value=\"Vasculitis Autoimmuno\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_5\">Vasculitis Autoimmuno<\/label><\/li><li class=\"choice-46 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_46\" name=\"wpforms[fields][67][]\" value=\"Par\u00e1lisis de Bell (par\u00e1lisis facial)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_46\">Par\u00e1lisis de Bell (par\u00e1lisis facial)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_6\" name=\"wpforms[fields][67][]\" value=\"Bronquitis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_6\">Bronquitis<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_7\" name=\"wpforms[fields][67][]\" value=\"Cancer\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_7\">Cancer<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_8\" name=\"wpforms[fields][67][]\" value=\"Enfermedad cel\u00edaca (intolerancia al gluten)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_8\">Enfermedad cel\u00edaca (intolerancia al gluten)<\/label><\/li><li class=\"choice-36 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_36\" name=\"wpforms[fields][67][]\" value=\"Enfermedad cr\u00f3nica renal\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_36\">Enfermedad cr\u00f3nica renal<\/label><\/li><li class=\"choice-33 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_33\" name=\"wpforms[fields][67][]\" value=\"Congestive Heart Failure\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_33\">Congestive Heart Failure<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_9\" name=\"wpforms[fields][67][]\" value=\"Enfermedad de Crohn\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_9\">Enfermedad de Crohn<\/label><\/li><li class=\"choice-37 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_37\" name=\"wpforms[fields][67][]\" value=\"Trombosis venosa profunda (Co\u00e1gulos de sangre)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_37\">Trombosis venosa profunda (Co\u00e1gulos de sangre)<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_10\" name=\"wpforms[fields][67][]\" value=\"Diabetes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_10\">Diabetes<\/label><\/li><li class=\"choice-38 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_38\" name=\"wpforms[fields][67][]\" value=\"Encefalitis (inflamaci\u00f3n cerebral\/dolores de cabeza)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_38\">Encefalitis (inflamaci\u00f3n cerebral\/dolores de cabeza)<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_11\" name=\"wpforms[fields][67][]\" value=\"Epilepsia (convulsiones)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_11\">Epilepsia (convulsiones)<\/label><\/li><li class=\"choice-34 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_34\" name=\"wpforms[fields][67][]\" value=\"La Enfermedad al coraz\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_34\">La Enfermedad al coraz\u00f3n<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_12\" name=\"wpforms[fields][67][]\" value=\"Herpes Type 1\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_12\">Herpes Type 1<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_13\" name=\"wpforms[fields][67][]\" value=\"Herpes Type 2\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_13\">Herpes Type 2<\/label><\/li><li class=\"choice-39 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_39\" name=\"wpforms[fields][67][]\" value=\"VIH\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_39\">VIH<\/label><\/li><li class=\"choice-40 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_40\" name=\"wpforms[fields][67][]\" value=\"Hipertension (Presi\u00f3n Sanguinea Elevada)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_40\">Hipertension (Presi\u00f3n Sanguinea Elevada)<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_14\" name=\"wpforms[fields][67][]\" value=\"Enfermedad inflamatoria intestinal\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_14\">Enfermedad inflamatoria intestinal<\/label><\/li><li class=\"choice-41 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_41\" name=\"wpforms[fields][67][]\" value=\"Enfermedad Renal, Aguda\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_41\">Enfermedad Renal, Aguda<\/label><\/li><li class=\"choice-35 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_35\" name=\"wpforms[fields][67][]\" value=\"Enfermedad del Higado\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_35\">Enfermedad del Higado<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_15\" name=\"wpforms[fields][67][]\" value=\"Lupus\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_15\">Lupus<\/label><\/li><li class=\"choice-42 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_42\" name=\"wpforms[fields][67][]\" value=\"Aborto Espont\u00e1neo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_42\">Aborto Espont\u00e1neo<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_16\" name=\"wpforms[fields][67][]\" value=\"Esclerosis m\u00faltiple\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_16\">Esclerosis m\u00faltiple<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_17\" name=\"wpforms[fields][67][]\" value=\"Miastenia gravis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_17\">Miastenia gravis<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_18\" name=\"wpforms[fields][67][]\" value=\"Infarto de miocardio (ataque al coraz\u00f3n)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_18\">Infarto de miocardio (ataque al coraz\u00f3n)<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_19\" name=\"wpforms[fields][67][]\" value=\"Miocarditis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_19\">Miocarditis<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_20\" name=\"wpforms[fields][67][]\" value=\"Osteoartritis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_20\">Osteoartritis<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_21\" name=\"wpforms[fields][67][]\" value=\"Pericarditis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_21\">Pericarditis<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_22\" name=\"wpforms[fields][67][]\" value=\"Anemia perniciosa\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_22\">Anemia perniciosa<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_23\" name=\"wpforms[fields][67][]\" value=\"Neumonia\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_23\">Neumonia<\/label><\/li><li class=\"choice-43 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_43\" name=\"wpforms[fields][67][]\" value=\"Parto prematuro\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_43\">Parto prematuro<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_24\" name=\"wpforms[fields][67][]\" value=\"Soriasis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_24\">Soriasis<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_25\" name=\"wpforms[fields][67][]\" value=\"Artritis psori\u00e1sica\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_25\">Artritis psori\u00e1sica<\/label><\/li><li class=\"choice-44 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_44\" name=\"wpforms[fields][67][]\" value=\"Embolia pulmonar\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_44\">Embolia pulmonar<\/label><\/li><li class=\"choice-26 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_26\" name=\"wpforms[fields][67][]\" value=\"Artritis Reumatoide\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_26\">Artritis Reumatoide<\/label><\/li><li class=\"choice-27 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_27\" name=\"wpforms[fields][67][]\" value=\"Herpes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_27\">Herpes<\/label><\/li><li class=\"choice-28 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_28\" name=\"wpforms[fields][67][]\" value=\"S\u00edndrome de Sjogren\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_28\">S\u00edndrome de Sjogren<\/label><\/li><li class=\"choice-45 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_45\" name=\"wpforms[fields][67][]\" value=\"Parto de mortinato\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_45\">Parto de mortinato<\/label><\/li><li class=\"choice-29 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_29\" name=\"wpforms[fields][67][]\" value=\"Accidente cerebrovascular o Embolia\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_29\">Accidente cerebrovascular o Embolia<\/label><\/li><li class=\"choice-30 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_30\" name=\"wpforms[fields][67][]\" value=\"Ataques isqu\u00e9micos transitorios (AIT)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_30\">Ataques isqu\u00e9micos transitorios (AIT)<\/label><\/li><li class=\"choice-31 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_31\" name=\"wpforms[fields][67][]\" value=\"Trastorno de la tiroides\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_31\">Trastorno de la tiroides<\/label><\/li><li class=\"choice-32 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_67_32\" name=\"wpforms[fields][67][]\" value=\"Colitis ulcerosa\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_67_32\">Colitis ulcerosa<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_20-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_20\">Otras condiciones no enumeradas<\/label><textarea id=\"wpforms-2981-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" ><\/textarea><\/div><div id=\"wpforms-2981-field_66-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_66\">Si desarroll\u00f3 un nuevo c\u00e1ncer o la recurrencia de un c\u00e1ncer existente despu\u00e9s de la vacuna contra el COVID, especifique el tipo de c\u00e1ncer.<\/label><input type=\"text\" id=\"wpforms-2981-field_66\" class=\"wpforms-field-medium\" name=\"wpforms[fields][66]\" ><\/div><div id=\"wpforms-2981-field_21-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_21\">Medicamentos recetados actuales: LISTA DE TODOS LAS MEDICAMENTOS Y DOSIS<\/label><textarea id=\"wpforms-2981-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" ><\/textarea><\/div><div id=\"wpforms-2981-field_62-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_62\">Nuevos medicamentos recetados que tuvieron que comenzar despu\u00e9s de la(s) vacuna(s) COVID<\/label><textarea id=\"wpforms-2981-field_62\" class=\"wpforms-field-medium\" name=\"wpforms[fields][62]\" ><\/textarea><\/div><div id=\"wpforms-2981-field_22-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"22\"><h3 id=\"wpforms-2981-field_22\">DESDE LA VACUNA DE COVID, \u00bfha tenido alguno de los siguientes s\u00edntomas?<\/h3><\/div><div id=\"wpforms-2981-field_23-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"23\"><label class=\"wpforms-field-label wpforms-label-hide\">Symptoms<\/label><ul id=\"wpforms-2981-field_23\"><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_23\" name=\"wpforms[fields][23][]\" value=\" S\u00edntomas de COVID o enfermedad de COVID\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_23\">S\u00edntomas de COVID o enfermedad de COVID<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_1\" name=\"wpforms[fields][23][]\" value=\"Disminuci\u00f3n del bienestar\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_1\">Disminuci\u00f3n del bienestar<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_2\" name=\"wpforms[fields][23][]\" value=\"Deterioro del estado de salud\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_2\">Deterioro del estado de salud<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_3\" name=\"wpforms[fields][23][]\" value=\"Incapacidad para participar en actividades rutinarias.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_3\">Incapacidad para participar en actividades rutinarias.<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_4\" name=\"wpforms[fields][23][]\" value=\"P\u00e9rdida de energ\u00eda\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_4\">P\u00e9rdida de energ\u00eda<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_5\" name=\"wpforms[fields][23][]\" value=\"Fatiga extrema\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_5\">Fatiga extrema<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_6\" name=\"wpforms[fields][23][]\" value=\"Dolor inexplicable\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_6\">Dolor inexplicable<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_7\" name=\"wpforms[fields][23][]\" value=\"Debilidad\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_7\">Debilidad<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_8\" name=\"wpforms[fields][23][]\" value=\"Fiebres inexplicables\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_8\">Fiebres inexplicables<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_10\" name=\"wpforms[fields][23][]\" value=\"Sensaciones corporales inexplicables\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_10\">Sensaciones corporales inexplicables<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_9\" name=\"wpforms[fields][23][]\" value=\"Sudores nocturnos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_9\">Sudores nocturnos<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_11\" name=\"wpforms[fields][23][]\" value=\"Sofocos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_11\">Sofocos<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_12\" name=\"wpforms[fields][23][]\" value=\"Intolerancia al fr\u00edo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_12\">Intolerancia al fr\u00edo<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_13\" name=\"wpforms[fields][23][]\" value=\"Intolerancia al calor\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_13\">Intolerancia al calor<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_14\" name=\"wpforms[fields][23][]\" value=\"Sensible a los cambios de temperatura\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_14\">Sensible a los cambios de temperatura<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_15\" name=\"wpforms[fields][23][]\" value=\"Cambio en la capacidad para caminar\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_15\">Cambio en la capacidad para caminar<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_16\" name=\"wpforms[fields][23][]\" value=\"Cambio en el pensamiento\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_16\">Cambio en el pensamiento<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_17\" name=\"wpforms[fields][23][]\" value=\"ya no me siento como antes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_17\">ya no me siento como antes<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_18\" name=\"wpforms[fields][23][]\" value=\"Aumento de peso inexplicable\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_18\">Aumento de peso inexplicable<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_19\" name=\"wpforms[fields][23][]\" value=\"P\u00e9rdida de peso inexplicable\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_19\">P\u00e9rdida de peso inexplicable<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_20\" name=\"wpforms[fields][23][]\" value=\"Sue\u00f1o fragmentado\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_20\">Sue\u00f1o fragmentado<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_21\" name=\"wpforms[fields][23][]\" value=\"no puedo dormir\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_21\">no puedo dormir<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_23_22\" name=\"wpforms[fields][23][]\" value=\"Insomnio\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_23_22\">Insomnio<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_25-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"25\"><label class=\"wpforms-field-label\">Cabeza, Ojos, Oido, Nariz, Boca y Nariz<\/label><ul id=\"wpforms-2981-field_25\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_1\" name=\"wpforms[fields][25][]\" value=\"Dolores de cabeza, &quot;plenitud&quot; dentro de la cabeza\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_1\">Dolores de cabeza, \"plenitud\" dentro de la cabeza<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_2\" name=\"wpforms[fields][25][]\" value=\"Dolores de cabeza, migra\u00f1a\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_2\">Dolores de cabeza, migra\u00f1a<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_3\" name=\"wpforms[fields][25][]\" value=\"Dolores de cabeza, tensi\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_3\">Dolores de cabeza, tensi\u00f3n<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_4\" name=\"wpforms[fields][25][]\" value=\"Dolores de cabeza, palpitantes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_4\">Dolores de cabeza, palpitantes<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_5\" name=\"wpforms[fields][25][]\" value=\"Dolores de cabeza, otros\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_5\">Dolores de cabeza, otros<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_6\" name=\"wpforms[fields][25][]\" value=\"Ojos secos o con ardor\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_6\">Ojos secos o con ardor<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_7\" name=\"wpforms[fields][25][]\" value=\"Visi\u00f3n de t\u00fanel\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_7\">Visi\u00f3n de t\u00fanel<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_8\" name=\"wpforms[fields][25][]\" value=\"Visi\u00f3n borrosa\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_8\">Visi\u00f3n borrosa<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_9\" name=\"wpforms[fields][25][]\" value=\"P\u00e9rdida de visi\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_9\">P\u00e9rdida de visi\u00f3n<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_10\" name=\"wpforms[fields][25][]\" value=\"Flotadores\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_10\">Flotadores<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_11\" name=\"wpforms[fields][25][]\" value=\"Dolor visual\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_11\">Dolor visual<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_12\" name=\"wpforms[fields][25][]\" value=\"Conjuntivitis (ojos rojos)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_12\">Conjuntivitis (ojos rojos)<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_13\" name=\"wpforms[fields][25][]\" value=\"Secreci\u00f3n de los ojos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_13\">Secreci\u00f3n de los ojos<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_14\" name=\"wpforms[fields][25][]\" value=\"P\u00e9rdida del gusto\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_14\">P\u00e9rdida del gusto<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_15\" name=\"wpforms[fields][25][]\" value=\"P\u00e9rdida del olfato\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_15\">P\u00e9rdida del olfato<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_16\" name=\"wpforms[fields][25][]\" value=\"Sensible a la luz\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_16\">Sensible a la luz<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_17\" name=\"wpforms[fields][25][]\" value=\"Sensible al sonido\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_17\">Sensible al sonido<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_18\" name=\"wpforms[fields][25][]\" value=\"Sinusitis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_18\">Sinusitis<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_19\" name=\"wpforms[fields][25][]\" value=\"Dolor de garganta\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_19\">Dolor de garganta<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_20\" name=\"wpforms[fields][25][]\" value=\"Ronquera\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_20\">Ronquera<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_21\" name=\"wpforms[fields][25][]\" value=\"Sabor met\u00e1lico\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_21\">Sabor met\u00e1lico<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_22\" name=\"wpforms[fields][25][]\" value=\"Manchas blancas en la lengua\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_22\">Manchas blancas en la lengua<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_23\" name=\"wpforms[fields][25][]\" value=\"Amigdalitis\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_23\">Amigdalitis<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_24\" name=\"wpforms[fields][25][]\" value=\"Infecciones cr\u00f3nicas del o\u00eddo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_24\">Infecciones cr\u00f3nicas del o\u00eddo<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_25\" name=\"wpforms[fields][25][]\" value=\"Zumbido en los o\u00eddos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_25\">Zumbido en los o\u00eddos<\/label><\/li><li class=\"choice-26 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_26\" name=\"wpforms[fields][25][]\" value=\"Dolor en la boca\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_26\">Dolor en la boca<\/label><\/li><li class=\"choice-27 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_27\" name=\"wpforms[fields][25][]\" value=\"Dolor de lengua\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_27\">Dolor de lengua<\/label><\/li><li class=\"choice-28 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_28\" name=\"wpforms[fields][25][]\" value=\"Ulceras en la boca\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_28\">Ulceras en la boca<\/label><\/li><li class=\"choice-29 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_29\" name=\"wpforms[fields][25][]\" value=\"Ampollas en la boca\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_29\">Ampollas en la boca<\/label><\/li><li class=\"choice-30 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_30\" name=\"wpforms[fields][25][]\" value=\"Cambios en la lengua\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_30\">Cambios en la lengua<\/label><\/li><li class=\"choice-31 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_31\" name=\"wpforms[fields][25][]\" value=\"\u00dalceras en la lengua\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_31\">\u00dalceras en la lengua<\/label><\/li><li class=\"choice-32 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_32\" name=\"wpforms[fields][25][]\" value=\"Ampollas en la lengua\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_32\">Ampollas en la lengua<\/label><\/li><li class=\"choice-33 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_33\" name=\"wpforms[fields][25][]\" value=\"Boca seca\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_33\">Boca seca<\/label><\/li><li class=\"choice-34 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_34\" name=\"wpforms[fields][25][]\" value=\"Dificultad al tragar\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_34\">Dificultad al tragar<\/label><\/li><li class=\"choice-35 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_25_35\" name=\"wpforms[fields][25][]\" value=\"&quot;Lump in the throat&quot;\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_25_35\">\"Lump in the throat\"<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_26-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"26\"><label class=\"wpforms-field-label\">Hematol\u00f3gico<\/label><ul id=\"wpforms-2981-field_26\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_1\" name=\"wpforms[fields][26][]\" value=\"Gl\u00f3bulos blancos bajos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_1\">Gl\u00f3bulos blancos bajos<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_2\" name=\"wpforms[fields][26][]\" value=\"Hemoglobina baja\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_2\">Hemoglobina baja<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_3\" name=\"wpforms[fields][26][]\" value=\"Hematocrito bajo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_3\">Hematocrito bajo<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_4\" name=\"wpforms[fields][26][]\" value=\"Gl\u00f3bulos rojos bajos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_4\">Gl\u00f3bulos rojos bajos<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_5\" name=\"wpforms[fields][26][]\" value=\"Plaquetas bajas\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_5\">Plaquetas bajas<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_6\" name=\"wpforms[fields][26][]\" value=\"Gl\u00f3bulos blancos altos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_6\">Gl\u00f3bulos blancos altos<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_7\" name=\"wpforms[fields][26][]\" value=\"Hemoglobina alta\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_7\">Hemoglobina alta<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_8\" name=\"wpforms[fields][26][]\" value=\"Hematocrito alto\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_8\">Hematocrito alto<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_9\" name=\"wpforms[fields][26][]\" value=\"D\u00edmero D alto\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_9\">D\u00edmero D alto<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_10\" name=\"wpforms[fields][26][]\" value=\"Troponina elevada\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_10\">Troponina elevada<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_11\" name=\"wpforms[fields][26][]\" value=\"C\u00e9lulas anormales\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_11\">C\u00e9lulas anormales<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_12\" name=\"wpforms[fields][26][]\" value=\"Cambio en la funci\u00f3n hep\u00e1tica\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_12\">Cambio en la funci\u00f3n hep\u00e1tica<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_26_13\" name=\"wpforms[fields][26][]\" value=\"Cambio en la funci\u00f3n renal\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_26_13\">Cambio en la funci\u00f3n renal<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_27-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"27\"><label class=\"wpforms-field-label\">Respiratorio<\/label><ul id=\"wpforms-2981-field_27\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_27_1\" name=\"wpforms[fields][27][]\" value=\"Dificultad para respirar\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_27_1\">Dificultad para respirar<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_27_2\" name=\"wpforms[fields][27][]\" value=\"Respiraci\u00f3n dolorosa\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_27_2\">Respiraci\u00f3n dolorosa<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_27_3\" name=\"wpforms[fields][27][]\" value=\"Dificultad para respirar durante la actividad.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_27_3\">Dificultad para respirar durante la actividad.<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_27_4\" name=\"wpforms[fields][27][]\" value=\"Sibilancias\/ silbido\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_27_4\">Sibilancias\/ silbido<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_27_5\" name=\"wpforms[fields][27][]\" value=\"Infecciones recurrentes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_27_5\">Infecciones recurrentes<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_27_6\" name=\"wpforms[fields][27][]\" value=\"Resfriados recurrentes, gripe\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_27_6\">Resfriados recurrentes, gripe<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_27_7\" name=\"wpforms[fields][27][]\" value=\"Tos inexplicable\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_27_7\">Tos inexplicable<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_27_8\" name=\"wpforms[fields][27][]\" value=\"Tosiendo sangre\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_27_8\">Tosiendo sangre<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_28-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"28\"><label class=\"wpforms-field-label\">Coraz\u00f3n y Vascular<\/label><ul id=\"wpforms-2981-field_28\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_1\" name=\"wpforms[fields][28][]\" value=\"Dolor o presi\u00f3n en el pecho\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_1\">Dolor o presi\u00f3n en el pecho<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_2\" name=\"wpforms[fields][28][]\" value=\"Palpitaciones del coraz\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_2\">Palpitaciones del coraz\u00f3n<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_3\" name=\"wpforms[fields][28][]\" value=\"Latido del coraz\u00f3n irregular\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_3\">Latido del coraz\u00f3n irregular<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_4\" name=\"wpforms[fields][28][]\" value=\"Frecuencia card\u00edaca r\u00e1pida\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_4\">Frecuencia card\u00edaca r\u00e1pida<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_5\" name=\"wpforms[fields][28][]\" value=\"El coraz\u00f3n palpitante\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_5\">El coraz\u00f3n palpitante<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_6\" name=\"wpforms[fields][28][]\" value=\"Ritmo card\u00edaco lento\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_6\">Ritmo card\u00edaco lento<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_7\" name=\"wpforms[fields][28][]\" value=\"Soplo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_7\">Soplo<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_8\" name=\"wpforms[fields][28][]\" value=\"Dolor subiendo por el brazo izquierdo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_8\">Dolor subiendo por el brazo izquierdo<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_9\" name=\"wpforms[fields][28][]\" value=\"Dolor en la mand\u00edbula izquierda\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_9\">Dolor en la mand\u00edbula izquierda<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_10\" name=\"wpforms[fields][28][]\" value=\"Presi\u00f3n arterial baja\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_10\">Presi\u00f3n arterial baja<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_11\" name=\"wpforms[fields][28][]\" value=\"Alta presi\u00f3n sangu\u00ednea\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_11\">Alta presi\u00f3n sangu\u00ednea<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_12\" name=\"wpforms[fields][28][]\" value=\"Colesterol alto\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_12\">Colesterol alto<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_13\" name=\"wpforms[fields][28][]\" value=\"Co\u00e1gulos de sangre\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_13\">Co\u00e1gulos de sangre<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_14\" name=\"wpforms[fields][28][]\" value=\"Venas vericosas\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_14\">Venas vericosas<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_28_15\" name=\"wpforms[fields][28][]\" value=\"Dolor en la(s) pierna(s)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_28_15\">Dolor en la(s) pierna(s)<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_29-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"29\"><label class=\"wpforms-field-label\">Pecho y Torso: Aplica para mujeres y hombres<\/label><ul id=\"wpforms-2981-field_29\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_29_1\" name=\"wpforms[fields][29][]\" value=\"Nuevos bultos en los senos)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_29_1\">Nuevos bultos en los senos)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_29_2\" name=\"wpforms[fields][29][]\" value=\"Senos doloridos o hinchados\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_29_2\">Senos doloridos o hinchados<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_29_3\" name=\"wpforms[fields][29][]\" value=\"Discharge from breasts\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_29_3\">Discharge from breasts<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_29_4\" name=\"wpforms[fields][29][]\" value=\"Secreci\u00f3n de los senos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_29_4\">Secreci\u00f3n de los senos<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_29_5\" name=\"wpforms[fields][29][]\" value=\"Hinchaz\u00f3n\/dolor en los pezones\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_29_5\">Hinchaz\u00f3n\/dolor en los pezones<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_29_6\" name=\"wpforms[fields][29][]\" value=\"Cambios en la piel de los pezones\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_29_6\">Cambios en la piel de los pezones<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_29_7\" name=\"wpforms[fields][29][]\" value=\"Erupci\u00f3n en el pecho\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_29_7\">Erupci\u00f3n en el pecho<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_30-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"30\"><label class=\"wpforms-field-label\">Digestivo<\/label><ul id=\"wpforms-2981-field_30\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_1\" name=\"wpforms[fields][30][]\" value=\"P\u00e9rdida de apetito inexplicable\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_1\">P\u00e9rdida de apetito inexplicable<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_2\" name=\"wpforms[fields][30][]\" value=\"Aumento inusual del apetito\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_2\">Aumento inusual del apetito<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_3\" name=\"wpforms[fields][30][]\" value=\"Indigesti\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_3\">Indigesti\u00f3n<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_4\" name=\"wpforms[fields][30][]\" value=\"Gas\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_4\">Gas<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_5\" name=\"wpforms[fields][30][]\" value=\"N\u00e1usea\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_5\">N\u00e1usea<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_6\" name=\"wpforms[fields][30][]\" value=\"Diarrea\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_6\">Diarrea<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_7\" name=\"wpforms[fields][30][]\" value=\"Estre\u00f1imiento\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_7\">Estre\u00f1imiento<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_8\" name=\"wpforms[fields][30][]\" value=\"V\u00f3mitos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_8\">V\u00f3mitos<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_9\" name=\"wpforms[fields][30][]\" value=\"V\u00f3mitos de sangre\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_9\">V\u00f3mitos de sangre<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_10\" name=\"wpforms[fields][30][]\" value=\"Calambres\/dolor abdominal\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_10\">Calambres\/dolor abdominal<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_11\" name=\"wpforms[fields][30][]\" value=\"Dolor rectal\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_11\">Dolor rectal<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_12\" name=\"wpforms[fields][30][]\" value=\"Sangre en las heces\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_12\">Sangre en las heces<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_13\" name=\"wpforms[fields][30][]\" value=\"Hemorroides\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_13\">Hemorroides<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_14\" name=\"wpforms[fields][30][]\" value=\"Ictericia\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_14\">Ictericia<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_15\" name=\"wpforms[fields][30][]\" value=\"U\u00f1as quebradizas y rugosas\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_15\">U\u00f1as quebradizas y rugosas<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_30_16\" name=\"wpforms[fields][30][]\" value=\"Sangrado de las enc\u00edas\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_30_16\">Sangrado de las enc\u00edas<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_31-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"31\"><label class=\"wpforms-field-label\">Endocrino<\/label><ul id=\"wpforms-2981-field_31\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_1\" name=\"wpforms[fields][31][]\" value=\"Baja az\u00facar en la sangre\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_1\">Baja az\u00facar en la sangre<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_2\" name=\"wpforms[fields][31][]\" value=\"nivel alto de az\u00facar en la sangre\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_2\">nivel alto de az\u00facar en la sangre<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_3\" name=\"wpforms[fields][31][]\" value=\"Adelgazamiento del cabello del cuero cabelludo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_3\">Adelgazamiento del cabello del cuero cabelludo<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_4\" name=\"wpforms[fields][31][]\" value=\"P\u00e9rdida de vello corporal\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_4\">P\u00e9rdida de vello corporal<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_5\" name=\"wpforms[fields][31][]\" value=\"Exceso de vello corporal\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_5\">Exceso de vello corporal<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_6\" name=\"wpforms[fields][31][]\" value=\"Disminuci\u00f3n de la sudoraci\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_6\">Disminuci\u00f3n de la sudoraci\u00f3n<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_7\" name=\"wpforms[fields][31][]\" value=\"Aumento de la sudoraci\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_7\">Aumento de la sudoraci\u00f3n<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_8\" name=\"wpforms[fields][31][]\" value=\"Metabolismo lento\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_8\">Metabolismo lento<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_9\" name=\"wpforms[fields][31][]\" value=\"Aumento de peso anormal\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_9\">Aumento de peso anormal<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_10\" name=\"wpforms[fields][31][]\" value=\"P\u00e9rdida de peso inexplicable\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_10\">P\u00e9rdida de peso inexplicable<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_11\" name=\"wpforms[fields][31][]\" value=\"Intolerancia al calor\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_11\">Intolerancia al calor<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_12\" name=\"wpforms[fields][31][]\" value=\"Intolerancia al fr\u00edo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_12\">Intolerancia al fr\u00edo<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_13\" name=\"wpforms[fields][31][]\" value=\"Sofocos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_13\">Sofocos<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_14\" name=\"wpforms[fields][31][]\" value=\"Sudores nocturnos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_14\">Sudores nocturnos<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_31_15\" name=\"wpforms[fields][31][]\" value=\"decoloraci\u00f3n de la piel\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_31_15\">decoloraci\u00f3n de la piel<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_32-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"32\"><label class=\"wpforms-field-label\">Reproductivo y vejiga<\/label><ul id=\"wpforms-2981-field_32\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_1\" name=\"wpforms[fields][32][]\" value=\"Infecciones de la vejiga\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_1\">Infecciones de la vejiga<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_2\" name=\"wpforms[fields][32][]\" value=\"Micci\u00f3n frecuente\/ orinar con frequencia\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_2\">Micci\u00f3n frecuente\/ orinar con frequencia<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_3\" name=\"wpforms[fields][32][]\" value=\"Fuga urinaria\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_3\">Fuga urinaria<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_4\" name=\"wpforms[fields][32][]\" value=\"Urgencia de orinar\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_4\">Urgencia de orinar<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_5\" name=\"wpforms[fields][32][]\" value=\"Dolor al orinar\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_5\">Dolor al orinar<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_6\" name=\"wpforms[fields][32][]\" value=\"Sangre en la orina\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_6\">Sangre en la orina<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_7\" name=\"wpforms[fields][32][]\" value=\"Co\u00e1gulos en la orina\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_7\">Co\u00e1gulos en la orina<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_8\" name=\"wpforms[fields][32][]\" value=\"Dificultad para orinar\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_8\">Dificultad para orinar<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_9\" name=\"wpforms[fields][32][]\" value=\"Infecciones vesicales recurrentes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_9\">Infecciones vesicales recurrentes<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_10\" name=\"wpforms[fields][32][]\" value=\"Candidiasis recurrentes\/ Algodoncillo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_10\">Candidiasis recurrentes\/ Algodoncillo<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_11\" name=\"wpforms[fields][32][]\" value=\"Incontinencia\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_11\">Incontinencia<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_12\" name=\"wpforms[fields][32][]\" value=\"Masa en la vejiga\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_12\">Masa en la vejiga<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_13\" name=\"wpforms[fields][32][]\" value=\"Co\u00e1gulos de sangre en la vejiga\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_13\">Co\u00e1gulos de sangre en la vejiga<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_14\" name=\"wpforms[fields][32][]\" value=\"Sequedad de vagina\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_14\">Sequedad de vagina<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_15\" name=\"wpforms[fields][32][]\" value=\"Los per\u00edodos se han detenido\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_15\">Los per\u00edodos se han detenido<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_16\" name=\"wpforms[fields][32][]\" value=\"Per\u00edodos irregulares\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_16\">Per\u00edodos irregulares<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_17\" name=\"wpforms[fields][32][]\" value=\"Per\u00edodos livianos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_17\">Per\u00edodos livianos<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_18\" name=\"wpforms[fields][32][]\" value=\"Per\u00edodos pesados\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_18\">Per\u00edodos pesados<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_19\" name=\"wpforms[fields][32][]\" value=\"Coagulaci\u00f3n con per\u00edodos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_19\">Coagulaci\u00f3n con per\u00edodos<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_20\" name=\"wpforms[fields][32][]\" value=\"Per\u00edodos excesivamente dolorosos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_20\">Per\u00edodos excesivamente dolorosos<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_25\" name=\"wpforms[fields][32][]\" value=\"Sangrado posparto prolongado\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_25\">Sangrado posparto prolongado<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_21\" name=\"wpforms[fields][32][]\" value=\"Disfunci\u00f3n er\u00e9ctil\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_21\">Disfunci\u00f3n er\u00e9ctil<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_22\" name=\"wpforms[fields][32][]\" value=\"Dolor de pene\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_22\">Dolor de pene<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_23\" name=\"wpforms[fields][32][]\" value=\"Cambios en la fertilidad\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_23\">Cambios en la fertilidad<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_32_24\" name=\"wpforms[fields][32][]\" value=\"Abortos naturales\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_32_24\">Abortos naturales<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_33-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"33\"><label class=\"wpforms-field-label\">Musculoesquel\u00e9tico<\/label><ul id=\"wpforms-2981-field_33\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_1\" name=\"wpforms[fields][33][]\" value=\"Dolor en las articulaciones\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_1\">Dolor en las articulaciones<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_2\" name=\"wpforms[fields][33][]\" value=\"Dolor de espalda\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_2\">Dolor de espalda<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_3\" name=\"wpforms[fields][33][]\" value=\"Dolor de cuello\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_3\">Dolor de cuello<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_4\" name=\"wpforms[fields][33][]\" value=\"P\u00e9rdida de altura\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_4\">P\u00e9rdida de altura<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_5\" name=\"wpforms[fields][33][]\" value=\"Entumecimiento y hormigueo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_5\">Entumecimiento y hormigueo<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_6\" name=\"wpforms[fields][33][]\" value=\"Piernas inquietas en el sue\u00f1o\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_6\">Piernas inquietas en el sue\u00f1o<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_7\" name=\"wpforms[fields][33][]\" value=\"Dolor de pierna\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_7\">Dolor de pierna<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_8\" name=\"wpforms[fields][33][]\" value=\"Dolor de cadera\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_8\">Dolor de cadera<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_9\" name=\"wpforms[fields][33][]\" value=\"Dolor de huesos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_9\">Dolor de huesos<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_10\" name=\"wpforms[fields][33][]\" value=\"M\u00fasculos adoloridos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_10\">M\u00fasculos adoloridos<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_11\" name=\"wpforms[fields][33][]\" value=\"Rango de movimiento reducido\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_11\">Rango de movimiento reducido<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_12\" name=\"wpforms[fields][33][]\" value=\"Rigidez en las articulaciones\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_12\">Rigidez en las articulaciones<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_13\" name=\"wpforms[fields][33][]\" value=\"Dificultad para caminar\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_13\">Dificultad para caminar<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_14\" name=\"wpforms[fields][33][]\" value=\"Espasmos musculares\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_14\">Espasmos musculares<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_17\" name=\"wpforms[fields][33][]\" value=\"Contracci\u00f3n musculares\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_17\">Contracci\u00f3n musculares<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_33_16\" name=\"wpforms[fields][33][]\" value=\"Debilidad muscular\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_33_16\">Debilidad muscular<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_34-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"34\"><label class=\"wpforms-field-label\">Piel<\/label><ul id=\"wpforms-2981-field_34\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_1\" name=\"wpforms[fields][34][]\" value=\"Acn\u00e9\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_1\">Acn\u00e9<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_2\" name=\"wpforms[fields][34][]\" value=\"For\u00fanculos, absceso, ampollas\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_2\">For\u00fanculos, absceso, ampollas<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_3\" name=\"wpforms[fields][34][]\" value=\"Moretones\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_3\">Moretones<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_4\" name=\"wpforms[fields][34][]\" value=\"Quistes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_4\">Quistes<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_5\" name=\"wpforms[fields][34][]\" value=\"Piel seca\/escamosa\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_5\">Piel seca\/escamosa<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_6\" name=\"wpforms[fields][34][]\" value=\"Eczema\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_6\">Eczema<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_7\" name=\"wpforms[fields][34][]\" value=\"Urticaria\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_7\">Urticaria<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_8\" name=\"wpforms[fields][34][]\" value=\"Picaz\u00f3n, hormigueo en la piel\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_8\">Picaz\u00f3n, hormigueo en la piel<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_9\" name=\"wpforms[fields][34][]\" value=\"Cambios de lunares\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_9\">Cambios de lunares<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_10\" name=\"wpforms[fields][34][]\" value=\"Cambios de pigmento\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_10\">Cambios de pigmento<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_11\" name=\"wpforms[fields][34][]\" value=\"Erupciones o sarpullido\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_11\">Erupciones o sarpullido<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_34_12\" name=\"wpforms[fields][34][]\" value=\"Heridas que no sanan\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_34_12\">Heridas que no sanan<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_35-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"35\"><label class=\"wpforms-field-label\">Neurol\u00f3gico<\/label><ul id=\"wpforms-2981-field_35\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_1\" name=\"wpforms[fields][35][]\" value=\"Convulsiones de nuevo inicio\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_1\">Convulsiones de nuevo inicio<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_2\" name=\"wpforms[fields][35][]\" value=\"Temblor\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_2\">Temblor<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_3\" name=\"wpforms[fields][35][]\" value=\"Espasmos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_3\">Espasmos<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_4\" name=\"wpforms[fields][35][]\" value=\"Entumecimiento\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_4\">Entumecimiento<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_5\" name=\"wpforms[fields][35][]\" value=\"Hormigueo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_5\">Hormigueo<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_6\" name=\"wpforms[fields][35][]\" value=\"Sensaciones de ardor\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_6\">Sensaciones de ardor<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_7\" name=\"wpforms[fields][35][]\" value=\"Sensaciones de descarga el\u00e9ctrica\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_7\">Sensaciones de descarga el\u00e9ctrica<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_8\" name=\"wpforms[fields][35][]\" value=\"Sensaci\u00f3n de &quot;alfileres y agujas&quot;\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_8\">Sensaci\u00f3n de \"alfileres y agujas\"<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_9\" name=\"wpforms[fields][35][]\" value=\"Sensaci\u00f3n de hormigueo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_9\">Sensaci\u00f3n de hormigueo<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_10\" name=\"wpforms[fields][35][]\" value=\"Contracciones musculares involuntarias\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_10\">Contracciones musculares involuntarias<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_11\" name=\"wpforms[fields][35][]\" value=\"Dolor inexplicable\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_11\">Dolor inexplicable<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_12\" name=\"wpforms[fields][35][]\" value=\"P\u00e9rdida de fuerza\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_12\">P\u00e9rdida de fuerza<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_13\" name=\"wpforms[fields][35][]\" value=\"Dificultad para mover el cuerpo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_13\">Dificultad para mover el cuerpo<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_14\" name=\"wpforms[fields][35][]\" value=\"Torpeza\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_14\">Torpeza<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_15\" name=\"wpforms[fields][35][]\" value=\"Cambio de saldo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_15\">Cambio de saldo<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_16\" name=\"wpforms[fields][35][]\" value=\"P\u00e9rdida de coordinaci\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_16\">P\u00e9rdida de coordinaci\u00f3n<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_17\" name=\"wpforms[fields][35][]\" value=\"Mareo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_17\">Mareo<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_18\" name=\"wpforms[fields][35][]\" value=\"V\u00e9rtigo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_18\">V\u00e9rtigo<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_19\" name=\"wpforms[fields][35][]\" value=\"Desmayos\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_19\">Desmayos<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_20\" name=\"wpforms[fields][35][]\" value=\"Niebla del cerebro&quot;\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_20\">Niebla del cerebro\"<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_21\" name=\"wpforms[fields][35][]\" value=\"Dificultad para concentrarse\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_21\">Dificultad para concentrarse<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_22\" name=\"wpforms[fields][35][]\" value=\"Confusi\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_22\">Confusi\u00f3n<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_23\" name=\"wpforms[fields][35][]\" value=\"Olvido\/p\u00e9rdida de memoria\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_23\">Olvido\/p\u00e9rdida de memoria<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_24\" name=\"wpforms[fields][35][]\" value=\"Discurso lento\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_24\">Discurso lento<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_25\" name=\"wpforms[fields][35][]\" value=\"Insomnio\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_25\">Insomnio<\/label><\/li><li class=\"choice-26 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_26\" name=\"wpforms[fields][35][]\" value=\"Sue\u00f1o inquieto y fragmentado\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_26\">Sue\u00f1o inquieto y fragmentado<\/label><\/li><li class=\"choice-27 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_27\" name=\"wpforms[fields][35][]\" value=\"Somnolencia (durante el d\u00eda)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_27\">Somnolencia (durante el d\u00eda)<\/label><\/li><li class=\"choice-28 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_35_28\" name=\"wpforms[fields][35][]\" value=\"Lesiones cerebrales\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_35_28\">Lesiones cerebrales<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_36-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"36\"><label class=\"wpforms-field-label\">Cambios Sicol\u00f3gicos<\/label><ul id=\"wpforms-2981-field_36\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_1\" name=\"wpforms[fields][36][]\" value=\"Agresi\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_1\">Agresi\u00f3n<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_2\" name=\"wpforms[fields][36][]\" value=\"Arrebatos de ira\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_2\">Arrebatos de ira<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_3\" name=\"wpforms[fields][36][]\" value=\"Irritabilidad\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_3\">Irritabilidad<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_4\" name=\"wpforms[fields][36][]\" value=\"Ataques de ansiedad\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_4\">Ataques de ansiedad<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_5\" name=\"wpforms[fields][36][]\" value=\"Pensamientos anormales\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_5\">Pensamientos anormales<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_6\" name=\"wpforms[fields][36][]\" value=\"Depresi\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_6\">Depresi\u00f3n<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_7\" name=\"wpforms[fields][36][]\" value=\"Miedo excesivo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_7\">Miedo excesivo<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_8\" name=\"wpforms[fields][36][]\" value=\"Obsesi\u00f3n\/compulsiones\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_8\">Obsesi\u00f3n\/compulsiones<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_9\" name=\"wpforms[fields][36][]\" value=\"Sin esperansas\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_9\">Sin esperansas<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_10\" name=\"wpforms[fields][36][]\" value=\"Retiro social\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_10\">Retiro social<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_11\" name=\"wpforms[fields][36][]\" value=\"Estado de \u00e1nimo elevado\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_11\">Estado de \u00e1nimo elevado<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_12\" name=\"wpforms[fields][36][]\" value=\"Cambios de humor\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_12\">Cambios de humor<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_13\" name=\"wpforms[fields][36][]\" value=\"Desesperaci\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_13\">Desesperaci\u00f3n<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_14\" name=\"wpforms[fields][36][]\" value=\"Ataques de p\u00e1nico\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_14\">Ataques de p\u00e1nico<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_15\" name=\"wpforms[fields][36][]\" value=\"Pensamientos suicidas\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_15\">Pensamientos suicidas<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_16\" name=\"wpforms[fields][36][]\" value=\"Recelo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_16\">Recelo<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_17\" name=\"wpforms[fields][36][]\" value=\"Pesadillas\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_17\">Pesadillas<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_18\" name=\"wpforms[fields][36][]\" value=\"Somnambulismo\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_18\">Somnambulismo<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_19\" name=\"wpforms[fields][36][]\" value=\"Aumento preocupaci\u00f3n\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_19\">Aumento preocupaci\u00f3n<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_20\" name=\"wpforms[fields][36][]\" value=\"Episodios de llanto\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_20\">Episodios de llanto<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-2981-field_36_21\" name=\"wpforms[fields][36][]\" value=\"Sentimientos de culpa\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2981-field_36_21\">Sentimientos de culpa<\/label><\/li><\/ul><\/div><div id=\"wpforms-2981-field_38-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-2981-field_38\">Comentarios adicionales<\/label><textarea id=\"wpforms-2981-field_38\" class=\"wpforms-field-medium\" name=\"wpforms[fields][38]\" ><\/textarea><\/div><div id=\"wpforms-2981-field_64-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"64\"><div id=\"wpforms-2981-field_64\"><p>Una vez que env\u00ede el Informe de eventos adversos de la vacuna COVID a la Fundaci\u00f3n Truth For Health, lo agregaremos a nuestra lista de correo electr\u00f3nico para recibir alertas e informes sobre nuestro trabajo. 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Vaccine Injury Reporting System<\/p>","protected":false},"author":3,"featured_media":2840,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3079","page","type-page","status-publish","has-post-thumbnail","hentry","fadeIn","image-hover-transition-effect","latest_post"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Informe de lesiones por Vacunas - Truth for Health Foundation<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.truthforhealth.org\/es\/informe-de-lesiones-por-vacunas\/\" \/>\n<meta property=\"og:locale\" content=\"es_MX\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Informe de lesiones por Vacunas - Truth for Health Foundation\" \/>\n<meta property=\"og:description\" content=\"Citizens&#8217; 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