SIRVA Questionnaire
Did you experience shoulder pain WITHIN 48 hours of vaccination?
YES
NO
Did you see a doctor for treatment within 45 days of the vaccination?
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 vaccination, did you receive any treatment for injuries to that shoulder?
YES
NO
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