Share your injury

Share Your Story

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 At anytime you can request your story be withdrawn from the webpage by emailing us.

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© Hoosiers for Medical Liberty
Paid for by the supporters of Hoosiers for Medical Liberty, a tax exempt non-profit organization under IRC 501(c)(4) which does not endorse, support, or oppose candidates for election.
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.