Register with React19

Thank you for registering with React19. Registration will allow you to tell your story on our site. If your or your loved one's injury has been reported to VAERS (the Vaccine Adverse Event Reporting System), registering with React19 will allow us to track your VAERS report, aid you in tracking your VAERS Report progress, and aid in advocating for others.

First, tell us a little about yourself

We will only use your State and Country in anything on our site.

Your Name(*)

Please enter the name!

City

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State(*)

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Non-US State

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Country(*)

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Phone

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What do you need assistance with most?

Access to Medical Care Teams
Lab Work
Medical Treatments
Financial Support due to loss of work

Financial Support due to medical expenses
More Information on research
More information on possible symptoms and solutions

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How did you hear about React19?

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Next, tell us about your or your loved one's injury

This information will allow us to help you track your VAERS report, alert you if it disappears from the public VAERS system and allow us to gather statistics and audit how the React 19 population is being represented within the VAERS system.

Injury Date(*)

Please enter your Injury Date.

Age at Injury(*)

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Sex(*)

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Did the injured die?(*)

Yes No Invalid Input

Name of Deceased

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Date of Death

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The Vaccines

You can add up to 4 groups of vaccine brand, date and lot #.

Vaccine 1(*)

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Vaccine Date(*)

Please enter your Vaccine Date

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Vaccine 2

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Vaccine Date

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Vaccine 3

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Vaccine Date

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Vaccine 4

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Vaccine Date

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Was this reported to VAERS(*)

Yes No Invalid Input

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Finally, create Your User Account

Your secure account will allow you to tell your story, find any potential matching reports in VAERS and notify you of changes to your report (officially assigned a VAERS ID) in the CDC’s VAERS system.

Pick a Username(*)

Please provide an username!

Your Email(*)

Please provide a valid e-mail!

Verify E-mail(*)

Retype the e-mail!

Password(*)

Please enter a password!

Verify Password(*)

Retype the password!

Are you a human?(*)

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