Real Reactions

Real REACTIONS Application

First Name

Last Name

Address

City

State

Zip Code

Phone

Record the injury in the federally mandated registry Vaccine Adverse Events Reporting Systems (VAERS). See above for help on that. Below, enter your VAERS ID number, then either paste in the letter they sent you, or upload it.

VAERS ID

VAERS Letter

You can either paste in what they sent you, below, or upload it in the next field.

VAERS File

Record the injury (depending on the injection – i.e., COVID-19 injections) with the Countermeasures Injury Compensation Program (CICP). See above for help on that. Below, enter you CICP ID number, then either paste in the letter they sent you, or upload it.

CIPC ID

CICP Letter

You can either paste in what they sent you, below, or upload it in the next field.

CIPC File

Your Injury

Tell us about your injury and how you've been affected financially.

I have sent my state senator copies of my injury reports along with a brief statement regarding my financial hardship.

I have sent a copies of my VAERS/CICP filing to the CDC and FDA.