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VICP Case Review Form

Which vaccine did you receive
Date of Vaccination
Month
Day
Year
How Soon After the Vaccine Did Symptoms Begin?
Same day
1-7 days
8-30 days
Over 30 days
Not sure
Have You Received Medical Treatment for This Injury?
Yes
No
Not yet, but plan to
Unsure
Have your symptoms lasted more than 6 months?
If you have ER summaries, vaccine records, or doctor notes, you may upload them here. Not required

This website provides general information only and is not legal advice.
Viewing this site or contacting Schuenke Law Firm, L.L.C. does not create
an attorney–client relationship. Case results depend on many factors and
past outcomes do not guarantee future results.

Schuenke Law Firm, L.L.C.

Licensed in Missouri and Illinois
Serving Northeast Missouri & West-Central Illinois in:
Personal Injury & Wrongful Death • Family & Divorce Law • Criminal Defense • Domestic Violence Defense • DUI Defense • Wills & Estate Documents

Nationwide support for:
VICP Vaccine Injury Claims • Mass Tort Litigation & Referrals

 Call: (217) 222-7420 Ext. 2
© 2025 Schuenke Law Firm, L.L.C. | All Rights Reserved

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