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Bioweapon Recovery
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2025
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First Name*
Last Name*
Email*
Phone*
Gender*
Male
Female
Age*
Body Weight*
Profession or former profession*
What brand of vaccine was administered to you (Pfizer, Moderna, Astra Zeneca, etc)*
One shot, two, or two plus followup boosters?*
Approximately how long ago was the last one?*
What symptoms have you been experiencing since you received your shots or boosters?*
Any co-morbidities (pre-existing health conditions that could have been worsened as a result of the vax) or any other details you would like to share with us
I acknowledge that the patient is able to walk and eat.
How did you hear about us?*
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