Share Your Real Story

FOR Medical Professionals — Submit Observations Here

Submit Your Own Personal C19 Vax Reaction Story

If you have personally experienced negative reactions as a result of the COVID-19 vaccinations, please submit your story in the form provided on this page.

Please give us your name (we will not release your name without your consent), your email (we will not give out your email to anyone), which vaccine you received, the state in which you live and your story.

Please keep your story short and to the point. Use only 100-200 words if possible.

SUBMIT YOUR STORY

Do you want to share your vaccination reaction story? Fill out the form below to share your story. Share what life for you was like before and after you took the vaccine, which vaccine you took and your personal story.

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Your Name *

First

Last

Your Email *

Your State *

Country *

Which Vaccine Did You Receive? *

Your Story *

May we post your story? *

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