SIRVA Questionnaire
Did you have a COVID-19 related vaccine injury?
Yes
No
Did you experience shoulder pain WITHIN 48 hours of getting the shot?
*
YES
NO
Did you see a doctor for treatment of the shoulder injury from the vaccine shot?
*
YES
NO
Has this been an ongoing problem for at least 6 months or have you had surgery on your shoulder?
*
YES
NO
In the two years BEFORE you the vaccine shot, did you get any treatment for injuries to that shoulder?
*
YES
NO
Submit
Should be Empty: