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Home
About
Services
Who can we help?
My legal issue
Open menu
Vaccine Injury
Remdesivir Liability
Malpractice Case
Claim Against US Company
Breach of Contract
Employment / Disability Claims
Death By Hospital
Workers Compensation
Experts
Whistleblowers
Attorneys
Contact
Breach of Contract
Step
1
of
16
6%
Where you told at the site of your shot about your rights to refuse the shot or about whether or not your shot was a EUA, an emergency use authorization?
(Required)
Yes
No
Not sure
Please upload a copy of any signed agreements.
Drop files here or
Select files
Accepted file types: jpg, jpeg, png, pdf, eml, mpeg-4, mp3, mp4, wav, Max. file size: 128 MB.
What other things were you told about the side effects or long term possible effects?
How many shots did you take?
Please enter a number greater than or equal to
1
.
What date (s) did you take a shot?
MM slash DD slash YYYY
What symptoms occurred and how soon after?
1 hour
2 hours
3 hours
Several hours
1 day
2 days
3 days
1 week
2 weeks
3 weeks
1 month
2+ months
other
What symptoms occurred and how soon after? : Others
Symptoms
First symptoms I experienced
Fatigue
Exercise Intolerance
Brain Fog
Heart Palpitations
Tingling (numbness)
Muscle Weakness
Dizziness
First symptoms I experienced
Muscle Aches
Sleep Disturbances
Anxiety / Adrenaline Surges
Join Pain (Arthritic)
Shortness of Breath
High Heart Rate
Insomnia
First symptoms I experienced
Nerve Pain
New Persistent Headaches
Muscle Twitching / Tremors
Feeling off balanced
Heaviness in Legs
Memory Loss
Rashes / Hives / Bruising
Have you been able to return to work?
Yes
No
Currently I am experiencing…
Fatigue
Exercise Intolerance
Brain Fog
Heart Palpitations
Tingling (numbness)
Muscle Weakness
Dizziness
Currently I am experiencing…
Muscle Aches
Sleep Disturbances
Anxiety / Adrenaline Surges
Join Pain (Arthritic)
Shortness of Breath
High Heart Rate
Insomnia
Currently I am experiencing…
Nerve Pain
New Persistent Headaches
Muscle Twitching / Tremors
Feeling off balanced
Heaviness in Legs
Memory Loss
Rashes / Hives / Bruising
Please describe everything you want to share with our attorneys so we can better be prepared if we decide to personally take this case or refer you to another legal expert.
Enter your contact information
Name
First
Last
Email
Phone
Address
Street Address
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City
State / Province / Region
Zip
United States
Australia
Canada
Israel
Country
Referred By?
Referred By?
Steve Kirsch
react19.org
Lori Bontell
Tom Renz, Esq.
Jeff Childers, Esq.
Mary Holland, Esq.
Robert Barnes, Esq.
Tricia Lindsay, Esq.
Bobbie Anne Flower-Cox, Esq.
Brook Jackson
Sujata Gibson, Esq.
Mark Meuser, Esq.
Tracy Henderson, Esq.
Pierre Kory, MD, MPA
Ryan Cole, MD
Robert Malone, MD
Paul Marik, MD
Meryl Nass, MD
Ralph Lorigo, Esq.
Beth Parlato, Esq.
Dana Wefer, Esq.
Deana Pollard-Sacks, Esq.
Priscilla Romans, RN
Steven M. Warschawsky, Esq.
Nicole Ward
Deborah Conrad, PA-C
Ryan Heath, Esq.
Rachel Rodriguez, Esq.
Kevin Barry, Esq.
Kathryn Huwig
Kyle Moore, Esq.
Scott Lloyd, Esq.
Marcus Thornton
Jeremy Friedman, Esq.
John Pfleiderer, Esq.
Lucia Sinatra
Tom Connors, Esq.
Tyce Patt
Chris Rake, MD
Kelly Mordecai, Esq.
James Mermigis, Esq.
John Beaudoin, Sr.
Lt. Col. (Ret.) Pete Chambers, DO
Rolf Hazlehurst, Esq.
David Gortler
Twitter
On High Alert
Other
Referred By? : Other
