Reporting a Vaccine Injury / Adverse Reaction

Adverse Reaction / Injury Form

Knights of the Cradle (Yort Knight) have set up a reporting system, relying on people to send in reports of their experience when taking a vaccine and the reactions / actions that occurred after. Anyone can fill out and submit a report to KOTC, including family, friends, doctors or report your own vaccine injury.

Feel free to share this page with anyone you know that would like to be involved in this movement and getting as much information out to public as possible. We do have bigger plans in the works involving anyone with a vaccine injury, and filling out the form below will help us know the details and keep in contact with you. YOU ARE NOT A STASTIC OR NUMBER. YOU ARE A PERSON WITH A FACE AND A STORY. 

* PRIVACY STATEMENT *
All data collected will be treated as confidentially. Our aim is to set up a data base and have this information accessible to the general public so everyone is informed of the issues people are facing when taking a vaccine and the risks involved. No names or personal details will be shared. Any details provided WILL NOT be shared / sold or passed onto a third party unless we have your written consent before hand.

I would like to thank you all for taking the time to fill out the below form. I hope you are going well at the moment during this difficulted time. If you need help, please reach out to us and we will try to put you InTouch with the right people. May God be with you and guide you during these dark time. Take care xoxo

Adverse Reactions Form