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Were you or a loved one administered the Gardasil vaccine?
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Age of patient when they received the Gardasil vaccine?
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Age of patient now?
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State where the Gardasil vaccine was received:
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Please list adverse symptoms that were experienced due to the Gardasil vaccine:
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Date symptoms or adverse reactions started:
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Date of medical diagnosis, if applicable:
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Please describe your experience:
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What date did you discover Gardasil caused these symptoms?
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How did you discover Gardasil caused these symptoms?
Was your case filed in Vaccine Court?
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If yes, please provide details:
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