CIPD Survey - Siri & Glimstad LLP

Have you received a vaccine in the past 3 years? *

Yes
No

Did you experience symptoms that may include impaired sensory function beginning in the toes and fingers, slurred speech, or problems breathing sometime after you received the vaccine? *

Yes
No

Have you ever considered the link between vaccines and your symptoms or discussed this with your doctor? *

Yes
No

Have you been diagnosed with CIPD or another condition following vaccine administration? *

Yes
No

Approximate month/year you received the vaccine in question: *

Approximate month/year you started experiencing these symptoms: *

Based on your responses, it is possible that your diagnosis may be due to a vaccine. You may be entitled to significant compensation through the Vaccine Injury Compensation Program. Click here to call us now to discuss your potential claim OR simply click Submit and your survey information will be routed to our vaccine injury team. There is NO cost for representation.

Based on your responses, it does not appear your diagnosis was related to a vaccine you received in the past three years, which is typically a pre-requisite for filing a claim for relied in the national vaccine injury compensation program.

What is your first and last name? *

First

Last

What is your email? *

What is your phone number? *

Submitting this form does not create an attorney-client relationship between you and the attorneys of Siri & Glimstad LLP. We may collect, use, and process your data according to the terms of our Privacy Policy.

Got CIPD?

Chronic Inflammatory Demyelinating Polyneuropathy

Take THE SURVEY now!