Citizens’ Vaccine Injury Reporting System

Medical Conditions: NEW ONSET since your COVID shot (check all that apply)

Since the COVID shot have you had WORSENING of any of the following EXISTING medical problems?

SINCE THE COVID SHOT, have you had any of the following symptoms?

Upon submission of the COVID Shot Adverse Event Report to Truth For Health Foundation we will add you to our E-mail list to receive alerts and reports on our work. This list is managed by MailChimp and you may unsubscribe at any time.