Diagnosed Myocarditis?
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Have you received a vaccine within the past 3 years or 1 year for Covid vaccine?
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Yes
No
Did you experience symptoms such as shortness of breath, chest pain, decreased ability to exercise, irregular heartbeat after you received the vaccine?
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Yes
No
If yes, which vaccine?
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Seasonal influenza (e.g., Flu)
Diphtheria (e.g., DTaP)
Hepatitis A
Hepatitis B
COVID-19
Human papillomavirus (e.g., HPV)
Other
Have you ever considered the link between the vaccines and your symptoms or discussed this with your doctor?
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Yes
No
Were you diagnosed with myocarditis following vaccine administration?
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Yes
No
Approximate month/year you received the vaccine in question:
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Approximate month/year you started experiencing these symptoms:
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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.
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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.
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