Share your injury

We are doing something new!

We currently have a nurse who is completing her Bachelor's degree precepting with us.

As part of her final project she is interviewing individuals who have had adverse events.

If you have had an adverse event you can help by completing the survey and then scheduling a zoom interview with her.

Ultimately, the goal is to improve nursing care for those experiencing vaccine adverse events or injuries.

Thank you for your help!

Share Your Story

If you are willing, please complete the survey from above. Only complete below this line if you are not willing to work with our student nurse.

H4ML also recognizes one of the greatest difficulties in adverse events or vaccine injury is feeling unheard, dismissed, and shunned. We want to ensure you are heard, your story is shared, and your journey is recognized. We commend you for your bravery in sharing as well as in fighting through adverse event or injury.

You are supported!

H4ML recognizes this is a sensitive topic and can be alienating in your personal life. We want you to feel comfortable in this space and ONLY share if you feel called to. If at some point you decide that your story is too personal to share, let us know. We will not share your personal information and will only share with the "signature" you choose.

* Indicates required field

Name *

First

Last

Email *

Zip Code *

Phone Number *

What vaccine caused your adverse event or injury? *

Have you or your provider reported your adverse event or injury to VAERS? *

Yes No

If reported to VAERS would you like to share your ID number? *

Please tell us your story. *

How would you like your story to be "signed." *

By submitting this form you agree to have your story shared by H4ML. At anytime you can request your story be withdrawn from the webpage by emailing us.

Submit

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© Hoosiers for Medical Liberty
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Please be advised that Hoosiers for Medical Liberty and it's team are not attorneys. The information shared within this website is solely for educational purposes and should not be construed as legal advice. If you act upon the information provided by Hoosiers for Medical Liberty you understand that you are doing such after careful consideration and at your own risk. Legal concerns should be addressed with an attorney.