{"id":32,"date":"2025-11-13T09:33:03","date_gmt":"2025-11-13T08:33:03","guid":{"rendered":"https:\/\/dokumentationsstelle.org\/formular\/?page_id=32"},"modified":"2025-11-15T15:23:55","modified_gmt":"2025-11-15T14:23:55","slug":"impfschaden-melden","status":"publish","type":"page","link":"https:\/\/dokumentationsstelle.org\/formular\/","title":{"rendered":"Dokumentationsstelle f\u00fcr Schweizer Covid-Injektions-Gesch\u00e4digte"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-f56f613f wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column has-global-padding is-layout-constrained wp-block-column-is-layout-constrained\" style=\"flex-basis:2500px\">\n<p class=\"wp-block-paragraph\">Bitte f\u00fcllen Sie das folgende Formular aus, um Ihren COVID Injektions-Schaden zu melden.<\/p>\n\n\n<div class=\"frm_forms  with_frm_style frm_style_formidable-stil\" id=\"frm_form_2_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_impfschaeden\" >\n<div class=\"frm_form_fields  frm_page_num_1\">\n<fieldset>\n<legend class=\"frm_screen_reader\">Impfschaden Datenbank<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<div class=\"frm_rootline_group\" role=\"group\" tabindex=\"0\" aria-label=\"Seite 1 von 6\" ><ul class=\"frm_page_bar frm_rootline_6 frm_progress frm_progress_line frm_no_numbers frm_show_lines frm_show_titles\"><li class=\"frm_rootline_single frm_current_page\"><span class=\"frm_rootline_title\">Impfungen<\/span><input type=\"button\" value=\"1\" data-page=\"\" class=\" frm_page_1\" aria-disabled=\"true\" data-field=\"0\" aria-label=\"Impfungen\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Nebenwirkungen<\/span><input type=\"button\" value=\"2\" data-page=\"30\" class=\"frm_page_skip frm_page_2\" data-field=\"113\" aria-label=\"Nebenwirkungen\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Weitere Fragen<\/span><input type=\"button\" value=\"3\" data-page=\"44\" class=\"frm_page_skip frm_page_3\" data-field=\"114\" aria-label=\"Weitere Fragen\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Kontaktdaten<\/span><input type=\"button\" value=\"4\" data-page=\"59\" class=\"frm_page_skip frm_page_4\" data-field=\"127\" aria-label=\"Kontaktdaten\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Diagnosen<\/span><input type=\"button\" value=\"5\" data-page=\"102\" class=\"frm_page_skip frm_page_5\" data-field=\"115\" aria-label=\"Diagnosen\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Finanzieller Schaden<\/span><input type=\"button\" value=\"6\" data-page=\"117\" class=\"frm_page_skip frm_page_6\" data-field=\"140\" aria-label=\"Finanzieller Schaden\"  \/><\/li><\/ul><div class=\"frm_clearfix\"><\/div><\/div><input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"2\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_2\" id=\"frm_hide_fields_2\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"impfschaeden\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_2\" name=\"frm_submit_entry_2\" value=\"0fcda30f9b\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/formular\/wp-json\/wp\/v2\/pages\/32\" \/><div id=\"frm_field_7_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Impfungen<\/h3>\r\n\r\n\r\n<div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12  frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n    <div  id=\"field_k2g762_label\" class=\"frm_primary_label\">Mit welchem Impstoff wurden Sie geimpft?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_k2g762_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_16-779-0\">\t\t\t<label  for=\"field_k2g762-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[16]\" id=\"field_k2g762-0\" value=\"Comirnaty (BioNTech, Pfizer)\"\n\t\t   data-sectionid=\"779\"  data-reqmsg=\"Mit welchem Impstoff wurden Sie geimpft? kann nicht leer sein.\" data-invmsg=\"Mit welchem Impstoff wurden Sie geimpft? ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Comirnaty (BioNTech, Pfizer)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_16-779-3\">\t\t\t<label  for=\"field_k2g762-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[16]\" id=\"field_k2g762-3\" value=\"Spikevax (Moderna)\"\n\t\t   data-sectionid=\"779\"  data-reqmsg=\"Mit welchem Impstoff wurden Sie geimpft? kann nicht leer sein.\" data-invmsg=\"Mit welchem Impstoff wurden Sie geimpft? ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Spikevax (Moderna)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_16-779-1\">\t\t\t<label  for=\"field_k2g762-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[16]\" id=\"field_k2g762-1\" value=\"Nuvaxovid (Novavax)\"\n\t\t   data-sectionid=\"779\"  data-reqmsg=\"Mit welchem Impstoff wurden Sie geimpft? kann nicht leer sein.\" data-invmsg=\"Mit welchem Impstoff wurden Sie geimpft? ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Nuvaxovid (Novavax)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_16-779-4\">\t\t\t<label  for=\"field_k2g762-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[16]\" id=\"field_k2g762-4\" value=\"Vaxzevria (AstraZeneca)\"\n\t\t   data-sectionid=\"779\"  data-reqmsg=\"Mit welchem Impstoff wurden Sie geimpft? kann nicht leer sein.\" data-invmsg=\"Mit welchem Impstoff wurden Sie geimpft? ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Vaxzevria (AstraZeneca)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_16-779-2\">\t\t\t<label  for=\"field_k2g762-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[16]\" id=\"field_k2g762-2\" value=\"Janssen (Johnson &amp; Johnson)\"\n\t\t   data-sectionid=\"779\"  data-reqmsg=\"Mit welchem Impstoff wurden Sie geimpft? kann nicht leer sein.\" data-invmsg=\"Mit welchem Impstoff wurden Sie geimpft? ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Janssen (Johnson &amp; Johnson)<\/div><\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_17_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm3\">\r\n    <label for=\"field_mq4yh\" id=\"field_mq4yh_label\" class=\"frm_primary_label\">Datum der 1. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_mq4yh\" name=\"item_meta[17]\" value=\"\"  data-sectionid=\"779\"  data-reqmsg=\"Datum der 1. Impfung  kann nicht leer sein.\" aria-required=\"true\" data-invmsg=\"Datum ist ung\u00fcltig\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_18_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_djn93\" id=\"field_djn93_label\" class=\"frm_primary_label\">Chargen-Nummer der 1. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_djn93\" name=\"item_meta[18]\" value=\"\"  data-sectionid=\"779\"  data-reqmsg=\"Chargen-Nummer der 1. Impfung  kann nicht leer sein.\" aria-required=\"true\" data-invmsg=\"Text ist ung\u00fcltig\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_djn93\" \/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_djn93\">Die Chargen-Nummer des Impftstoffs finden Sie im Impfzertifikat (ausgedruckt oder digital).<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_19_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first spacingTop horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n    <div  id=\"field_4vrti_label\" class=\"frm_primary_label\">Impfstoff der 2. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_4vrti_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_19-779-0\">\t\t\t<label  for=\"field_4vrti-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[19]\" id=\"field_4vrti-0\" value=\"Comirnaty (BioNTech, Pfizer)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 2. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Comirnaty (BioNTech, Pfizer)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_19-779-3\">\t\t\t<label  for=\"field_4vrti-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[19]\" id=\"field_4vrti-3\" value=\"Spikevax (Moderna)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 2. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Spikevax (Moderna)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_19-779-1\">\t\t\t<label  for=\"field_4vrti-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[19]\" id=\"field_4vrti-1\" value=\"Nuvaxovid (Novavax)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 2. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Nuvaxovid (Novavax)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_19-779-4\">\t\t\t<label  for=\"field_4vrti-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[19]\" id=\"field_4vrti-4\" value=\"Vaxzevria (AstraZeneca)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 2. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Vaxzevria (AstraZeneca)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_19-779-2\">\t\t\t<label  for=\"field_4vrti-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[19]\" id=\"field_4vrti-2\" value=\"Janssen (Johnson &amp; Johnson)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 2. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Janssen (Johnson &amp; Johnson)<\/div><\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_20_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm3\">\r\n    <label for=\"field_qel2i\" id=\"field_qel2i_label\" class=\"frm_primary_label\">Datum der 2. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qel2i\" name=\"item_meta[20]\" value=\"\"  data-sectionid=\"779\"  data-invmsg=\"Datum ist ung\u00fcltig\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_21_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_wypni\" id=\"field_wypni_label\" class=\"frm_primary_label\">Chargen-Nummer der 2. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_wypni\" name=\"item_meta[21]\" value=\"\"  data-sectionid=\"779\"  data-invmsg=\"Text ist ung\u00fcltig\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_wypni\" \/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_wypni\">Die Chargen-Nummer des Impftstoffs finden Sie im Impfzertifikat (ausgedruckt oder digital).<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first spacingTop horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n    <div  id=\"field_5hxwf_label\" class=\"frm_primary_label\">Impfstoff der 3. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_5hxwf_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_22-779-0\">\t\t\t<label  for=\"field_5hxwf-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_5hxwf-0\" value=\"Comirnaty (BioNTech, Pfizer)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 3. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Comirnaty (BioNTech, Pfizer)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_22-779-3\">\t\t\t<label  for=\"field_5hxwf-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_5hxwf-3\" value=\"Spikevax (Moderna)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 3. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Spikevax (Moderna)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_22-779-1\">\t\t\t<label  for=\"field_5hxwf-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_5hxwf-1\" value=\"Nuvaxovid (Novavax)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 3. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Nuvaxovid (Novavax)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_22-779-4\">\t\t\t<label  for=\"field_5hxwf-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_5hxwf-4\" value=\"Vaxzevria (AstraZeneca)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 3. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Vaxzevria (AstraZeneca)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_22-779-5\">\t\t\t<label  for=\"field_5hxwf-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_5hxwf-5\" value=\"Janssen (Johnson &amp; Johnson)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 3. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Janssen (Johnson &amp; Johnson)<\/div><\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_23_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm3\">\r\n    <label for=\"field_c9j6v\" id=\"field_c9j6v_label\" class=\"frm_primary_label\">Datum der 3. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_c9j6v\" name=\"item_meta[23]\" value=\"\"  data-sectionid=\"779\"  data-invmsg=\"Datum ist ung\u00fcltig\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_24_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_vfbdo\" id=\"field_vfbdo_label\" class=\"frm_primary_label\">Chargen-Nummer der 3. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_vfbdo\" name=\"item_meta[24]\" value=\"\"  data-sectionid=\"779\"  data-invmsg=\"Text ist ung\u00fcltig\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_vfbdo\" \/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_vfbdo\">Die Chargen-Nummer des Impftstoffs finden Sie im Impfzertifikat (ausgedruckt oder digital).<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_25_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first spacingTop horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n    <div  id=\"field_mq41l_label\" class=\"frm_primary_label\">Impfstoff der 4. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_mq41l_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_25-779-0\">\t\t\t<label  for=\"field_mq41l-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[25]\" id=\"field_mq41l-0\" value=\"Comirnaty (BioNTech, Pfizer)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 4. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Comirnaty (BioNTech, Pfizer)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_25-779-3\">\t\t\t<label  for=\"field_mq41l-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[25]\" id=\"field_mq41l-3\" value=\"Spikevax (Moderna)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 4. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Spikevax (Moderna)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_25-779-1\">\t\t\t<label  for=\"field_mq41l-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[25]\" id=\"field_mq41l-1\" value=\"Nuvaxovid (Novavax)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 4. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Nuvaxovid (Novavax)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_25-779-4\">\t\t\t<label  for=\"field_mq41l-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[25]\" id=\"field_mq41l-4\" value=\"Vaxzevria (AstraZeneca)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 4. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Vaxzevria (AstraZeneca)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_25-779-5\">\t\t\t<label  for=\"field_mq41l-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[25]\" id=\"field_mq41l-5\" value=\"Janssen (Johnson &amp; Johnson)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 4. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Janssen (Johnson &amp; Johnson)<\/div><\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_26_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm3\">\r\n    <label for=\"field_lqh6d\" id=\"field_lqh6d_label\" class=\"frm_primary_label\">Datum der 4. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_lqh6d\" name=\"item_meta[26]\" value=\"\"  data-sectionid=\"779\"  data-invmsg=\"Datum ist ung\u00fcltig\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_27_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_v40jr\" id=\"field_v40jr_label\" class=\"frm_primary_label\">Chargen-Nummer der 4. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_v40jr\" name=\"item_meta[27]\" value=\"\"  data-sectionid=\"779\"  data-invmsg=\"Text ist ung\u00fcltig\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_v40jr\" \/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_v40jr\">Die Chargen-Nummer des Impftstoffs finden Sie im Impfzertifikat (ausgedruckt oder digital).<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_28_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first spacingTop horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n    <div  id=\"field_ixc7w_label\" class=\"frm_primary_label\">Impfstoff der 5. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ixc7w_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_28-779-0\">\t\t\t<label  for=\"field_ixc7w-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[28]\" id=\"field_ixc7w-0\" value=\"Comirnaty (BioNTech, Pfizer)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 5. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Comirnaty (BioNTech, Pfizer)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_28-779-3\">\t\t\t<label  for=\"field_ixc7w-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[28]\" id=\"field_ixc7w-3\" value=\"Spikevax (Moderna)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 5. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Spikevax (Moderna)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_28-779-1\">\t\t\t<label  for=\"field_ixc7w-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[28]\" id=\"field_ixc7w-1\" value=\"Nuvaxovid (Novavax)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 5. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Nuvaxovid (Novavax)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_28-779-4\">\t\t\t<label  for=\"field_ixc7w-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[28]\" id=\"field_ixc7w-4\" value=\"Vaxzevria (AstraZeneca)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 5. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Vaxzevria (AstraZeneca)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_28-779-5\">\t\t\t<label  for=\"field_ixc7w-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[28]\" id=\"field_ixc7w-5\" value=\"Janssen (Johnson &amp; Johnson)\"\n\t\t   data-sectionid=\"779\"  data-invmsg=\"Impfstoff der 5. Impfung  ist ung\u00fcltig\"  \/> <div class=\"frm_label_button_container\">Janssen (Johnson &amp; Johnson)<\/div><\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_29_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm3\">\r\n    <label for=\"field_yqqjb\" id=\"field_yqqjb_label\" class=\"frm_primary_label\">Datum der 5. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yqqjb\" name=\"item_meta[29]\" value=\"\"  data-sectionid=\"779\"  data-invmsg=\"Datum ist ung\u00fcltig\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_30_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_ag50t\" id=\"field_ag50t_label\" class=\"frm_primary_label\">Chargen-Nummer der 5. Impfung \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ag50t\" name=\"item_meta[30]\" value=\"\"  data-sectionid=\"779\"  data-invmsg=\"Text ist ung\u00fcltig\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ag50t\" \/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ag50t\">Die Chargen-Nummer des Impftstoffs finden Sie im Impfzertifikat (ausgedruckt oder digital).<\/div>\r\n    \r\n<\/div>\n<\/div>\n<input type=\"hidden\" name=\"frm_page_order_2\" id=\"frm_page_order_2\" value=\"30\" \/><input type=\"hidden\" name=\"item_meta[32]\" id=\"field_uvg38\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[33]\" id=\"field_opc35-0\" value=\"\"  data-sectionid=\"773\"     \/>\n<input type=\"hidden\" name=\"item_meta[112]\" id=\"field_we0ue\" value=\"\"  data-sectionid=\"32\"     \/>\n<input type=\"hidden\" name=\"item_meta[117]\" id=\"field_tb9et\" value=\"\"  data-sectionid=\"32\"     \/>\n<input type=\"hidden\" name=\"item_meta[118]\" id=\"field_wz1e4\" value=\"\"  data-sectionid=\"32\"     \/>\n<input type=\"hidden\" name=\"item_meta[119]\" id=\"field_ok4h9\" value=\"\"  data-sectionid=\"32\"     \/>\n<input type=\"hidden\" name=\"item_meta[35]\" id=\"field_j3gos\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[114]\" id=\"field_f7mch\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[120]\" id=\"field_61yfm\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[122]\" id=\"field_4pumc-0\" value=\"\"  data-sectionid=\"120\"     \/>\n<input type=\"hidden\" name=\"item_meta[124]\" id=\"field_s8e8k-0\" value=\"\"  data-sectionid=\"120\"     \/>\n<input type=\"hidden\" name=\"item_meta[123]\" id=\"field_n8gxi\" value=\"\"  data-sectionid=\"120\"     \/>\n<input type=\"hidden\" name=\"item_meta[40]\" id=\"field_13kjy-0\" value=\"\"  data-sectionid=\"120\"     \/>\n<input type=\"hidden\" name=\"item_meta[126]\" id=\"field_t6eap-0\" value=\"\"  data-sectionid=\"120\"     \/>\n<input type=\"hidden\" name=\"item_meta[121]\" id=\"field_sr301\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[127]\" id=\"field_8236a\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[128]\" id=\"field_828a7-0\" value=\"Ja\"  data-frmval=\"Ja\"   \/>\n<input type=\"hidden\" name=\"item_meta[70]\" id=\"field_zec502\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[71]\" id=\"field_wkphn2-0\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[74]\" id=\"field_s4x6\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[75]\" id=\"field_4bx0y\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[76]\" id=\"field_1w5mn2\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[77]\" id=\"field_ckxxr2\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[78]\" id=\"field_2s8lx2\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[79]\" id=\"field_uq1f6\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[80]\" id=\"field_z1x782\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[81]\" id=\"field_ixlvx2\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[153]\" id=\"field_84swa\" value=\"\"  data-sectionid=\"70\"     \/>\n<input type=\"hidden\" name=\"item_meta[82]\" id=\"field_wvi4a2\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[129]\" id=\"field_fvtgn\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[130]\" id=\"field_vnz63-0\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[131]\" id=\"field_o3dcr\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[132]\" id=\"field_8yyew\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[133]\" id=\"field_l1cjf\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[134]\" id=\"field_lx4vm\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[135]\" id=\"field_1q6na\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[136]\" id=\"field_l2dqg\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[137]\" id=\"field_9xhrc\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[138]\" id=\"field_jaoa3\" value=\"\"  data-sectionid=\"722\"     \/>\n<input type=\"hidden\" name=\"item_meta[139]\" id=\"field_c6huu\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[151]\" id=\"field_4bqru\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[125]\" id=\"field_920q8-0\" value=\"\"  data-sectionid=\"151\"     \/>\n<input type=\"hidden\" name=\"item_meta[152]\" id=\"field_zkldf\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[115]\" id=\"field_z8yfe\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[36]\" id=\"field_m8g6o\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[37]\" id=\"field_ahnqz-0\" value=\"\"  data-sectionid=\"782\"     \/>\n<input type=\"hidden\" name=\"item_meta[38]\" id=\"field_bwmfm\" value=\"\"  data-sectionid=\"782\"     \/>\n<input type=\"hidden\" name=\"item_meta[39]\" id=\"field_9srpl\" value=\"\"  data-sectionid=\"782\"     \/>\n<input type=\"hidden\" name=\"item_meta[41]\" id=\"field_rxuwe-0\" value=\"\"  data-sectionid=\"782\"     \/>\n<input type=\"hidden\" name=\"item_meta[143]\" id=\"field_angae\" value=\"\"  data-sectionid=\"36\"     \/>\n<input type=\"hidden\" name=\"item_meta[42]\" id=\"field_q1qb1\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[140]\" id=\"field_hvbj\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[141]\" id=\"field_x3d0o\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[145]\" id=\"field_oi5yx\" value=\"\"  data-sectionid=\"141\"     \/>\n<input type=\"hidden\" name=\"item_meta[144]\" id=\"field_6prkh\" value=\"\"  data-sectionid=\"141\"     \/>\n<input type=\"hidden\" name=\"item_meta[146]\" id=\"field_y1lu9\" value=\"\"  data-sectionid=\"141\"     \/>\n<input type=\"hidden\" name=\"item_meta[147]\" id=\"field_qmo4g\" value=\"\"  data-sectionid=\"141\"     \/>\n<input type=\"hidden\" name=\"item_meta[148]\" id=\"field_4y018\" value=\"\"  data-sectionid=\"141\"     \/>\n<input type=\"hidden\" name=\"item_meta[149]\" id=\"field_x8nrz\" value=\"\"  data-sectionid=\"141\"     \/>\n<input type=\"hidden\" name=\"item_meta[142]\" id=\"field_2763u\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[150]\" id=\"field_ees08\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[89]\" id=\"field_yaa162-0\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[110]\" id=\"field_uz1r62\" value=\"\" data-frmval=\"\"\/>\n<input type=\"hidden\" name=\"item_meta[111]\" id=\"field_uym1j\" value=\"\"     \/>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_154_container\">\n\t\t\t<label for=\"field_tmg0z\" >\n\t\t\t\tFalls Du menschlich bist, lasse dieses Feld leer.\t\t\t<\/label>\n\t\t\t<input  id=\"field_tmg0z\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[154]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"7f\/XGAWUYHFknPPEGkR7VbK\/lDVks5Yj0yy6kr6mSxU4uWUs+8tekq5p8AktXzl0\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit\" type=\"submit\"  >Weiter<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n<\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Bitte f\u00fcllen Sie das folgende Formular aus, um Ihren COVID Injektions-Schaden zu melden.<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-32","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/dokumentationsstelle.org\/formular\/wp-json\/wp\/v2\/pages\/32","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dokumentationsstelle.org\/formular\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dokumentationsstelle.org\/formular\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dokumentationsstelle.org\/formular\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/dokumentationsstelle.org\/formular\/wp-json\/wp\/v2\/comments?post=32"}],"version-history":[{"count":10,"href":"https:\/\/dokumentationsstelle.org\/formular\/wp-json\/wp\/v2\/pages\/32\/revisions"}],"predecessor-version":[{"id":58,"href":"https:\/\/dokumentationsstelle.org\/formular\/wp-json\/wp\/v2\/pages\/32\/revisions\/58"}],"wp:attachment":[{"href":"https:\/\/dokumentationsstelle.org\/formular\/wp-json\/wp\/v2\/media?parent=32"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}