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If you have more than one person with clots to report on, then please provide that information in the "Comments" section at the end of this survey.

If you are comfortable with sharing your observations publicly, please contact Mr. Thomas Haviland at thomashaviland@sbcglobal.net

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* 1. In what US state do you live? (If you live outside the US, then please select that option.)

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* 2. Have you or anyone that you know had blood clotting issues that started after January 2020?

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* 3. What years (mark ALL that apply) have you or the person that you know had these blood clotting issues?

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* 4. Did the person with the clots take the Covid-19 vaccine?

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* 5. What years (mark ALL that apply) did the person with the clots take the Covid-19 vaccine?

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* 6. How soon did the person develop the blood clotting issue after taking the Covid-19 vaccine?

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* 7. The blood clotting issue was in what part of the body? (Mark ALL that apply)

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* 8. How was the blood clotting issue resolved?

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* 9. If the person's clot was physically removed by a doctor, would you be willing to share that doctor's name?

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* 10. If you answered "Yes" to Question 9, please provide the doctor's full name and contact information in the box below.

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* 11. COMMENTS: Please take a few moments to describe in more detail your or the person you know's blood clot issue, how it was resolved, and any potential link to the Covid-19 vaccine.

For information regarding the white fibrous clots: https://laurakasner.substack.com/p/the-clots-are-still-being-found-a
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