Shoulder Injury Survey - Siri & Glimstad LLP

Have you had severe shoulder pain in the past three years? *

Yes
No

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

Yes
No

Did your pain start after receiving a vaccine? *

Yes
No

How long has your shoulder pain lasted? *

less than 24 hours
greater than 24 hours

What vaccine(s) did you receive immediately prior to your pain starting? Choose all that apply: *

Have you been diagnosed with SIRVA (Shoulder Injury Related to Vaccine Administration)?: *

Yes
No

Did you seek medical attention for your shoulder injury? *

Yes
No

Based on your responses, it is possible that your shoulder injury 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 or simply click Submit and your survey information will be routed to our shoulder injury team. There is NO cost for representation.

Based on your responses, it does not appear your shoulder injury 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 SHOULDER PAIN?

Take THE SURVEY now!