Vaccine form you can present to your physician if you do not wish for your child to receive vaccines......Check the ingredient list!

NOT that any would ever sign such a thing....but this is a very important educational tool for all involved. Watch any physician's reaction. Because as Dr. Mercola has said, "Because the truth is, your pediatrician is not taking responsibility for any adverse reactions or damage that happens to your child, and neither are the pharmaceutical companies that manufacture the vaccines that injure countless children each year. Vaccine companies have long ago used political manipulation through their strong lobbying efforts to created legislation that essentially immunizes them against any law suit damages or awards.

The Homeland Security bill also contains a provision that protects manufacturers of vaccines that contain thimerosal from liability in vaccine-related lawsuits. Pro-vaccine-safety educators have long been saying that vaccines can over-stimulate your child’s immune system, sometimes causing the very disease it’s designed to protect against, or worse. And, when several vaccines are administered together, or in close succession, their interaction may completely overwhelm your child’s developing immune system."

If you read the form below, you will see a long list of potentially toxic chemicals – fillers and adjuvants -- that are included in various vaccines given to newborns and children.

If your child is vaccinated according to the CDC's recommended schedule, by the time your child starts kindergarten he or she will have received 48 doses of 14 vaccines. Of these, 36 doses will be given during the first 18 months of life.

Public health officials have NEVER proven that it is indeed safe to inject this number and volume of vaccines into infants. What's more, they cannot explain why, concurrent with an increasing number of vaccinations, there has been an explosion of neurological and immune system disorders in American children.

Something to think about....we all have to be proactive in our own health and the health of our children. I am not necessarily against vaccinations...but I believe vaccines have a long way to go before they are really "safe" to give to animals let alone adults or children.

We can no longer continue to have the mentality that health officials always know best and whatever they say goes. They do not always know best...some do not want to keep current on new medical methods or even really give a crap anymore about some issues. They too get caught up in their own business and requirements thereof. EVEN the FDA is not keeping us safe. BIG PHARMA is not.

For years we have all just thrust the arms of our kids out blindly to the physician or nurse to inject with a shot.....vaccination.....tests....when it may not really have been that safe to just ASSUME it was safe to do so. We did not even bother to question or ask. I know my grandmother is of the generation that would NEVER question anything her physician tells her to do. She does it usually regardless. It is our health and future lives hanging in the threshold now as well as our kids. We cannot afford to be so gullible or blind any longer. We have to do our own research and make our own decisions and not be afraid to stand up for our choices.


Physician's Warranty of Vaccine Safety

I (Physician's name, degree)_________________________, _____ am a physician licensed to practice medicine in the State of ________________. My State license number is _______________ , and my DEA number is _______________. My medical specialty is ________________________

I have a thorough understanding of the risks and benefits of all the medications that I prescribe for or administer to my patients. In the case of (Patient's name) ___________________________ , age _________ , whom I have examined, I find that certain risk factors exist that justify the recommended vaccinations. The following is a list of said risk factors and the vaccinations that will protect against them:

Risk Factor ____________________________________________

Vaccination ___________________________________________

Risk Factor ____________________________________________

Vaccination ___________________________________________

Risk Factor ____________________________________________

Vaccination ___________________________________________

Risk Factor ____________________________________________

Vaccination ___________________________________________

Risk Factor ____________________________________________

Vaccination ___________________________________________

Risk Factor ____________________________________________

Vaccination ___________________________________________



I am aware that vaccines typically contain many of the following fillers:

* aluminum hydroxide

* aluminum phosphate

* ammonium sulfate

* amphotericin B

* animal tissues: pig blood, horse blood, rabbit brain,

* dog kidney, monkey kidney,

* chick embryo, chicken egg, duck egg

* calf (bovine) serum

* betapropiolactone

* fetal bovine serum

* formaldehyde

* formalin

* gelatin

* glycerol

* human diploid cells (originating from human aborted fetal tissue)

* hydrolized gelatin

* mercury thimerosol (thimerosal, Merthiolate(r))

* monosodium glutamate (MSG)

* neomycin

* neomycin sulfate

* phenol red indicator

* phenoxyethanol (antifreeze)

* potassium diphosphate

* potassium monophosphate

* polymyxin B

* polysorbate 20

* polysorbate 80

* porcine (pig) pancreatic hydrolysate of casein

* residual MRC5 proteins

* sorbitol

* tri(n)butylphosphate,

* VERO cells, a continuous line of monkey kidney cells, and

* washed sheep red blood

and, hereby, warrant that these ingredients are safe for injection into the body of my patient. I have researched reports to the contrary, such as reports that mercury thimerosol causes severe neurological and immunological damage, and find that they are not credible.

I am aware that some vaccines have been found to have been contaminated with Simian Virus 40 (SV 40) and that SV 40 is causally linked by some researchers to non-Hodgkin's lymphoma and mesotheliomas in humans as well as in experimental animals. I hereby warrant that the vaccines I employ in my practice do not contain SV 40 or any other live viruses. (Alternately, I hereby warrant that said SV-40 virus or other viruses pose no substantive risk to my patient.)

I hereby warrant that the vaccines I am recommending for the care of (Patient's name) _______________ _______________________ do not contain any tissue from aborted human babies (also known as "fetuses").

In order to protect my patient's well being, I have taken the following steps to guarantee that the vaccines I will use will contain no damaging contaminants.

STEPS TAKEN: ______________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________



I have personally investigated the reports made to the VAERS (Vaccine Adverse Event Reporting System) and state that it is my professional opinion that the vaccines I am recommending are safe for administration to a child under the age of 5 years.

The bases for my opinion are itemized on Exhibit A , attached hereto, -- "Physician's Bases for Professional Opinion of Vaccine Safety." (Please itemize each recommended vaccine separately along with the bases for arriving at the conclusion that the vaccine is safe for administration to a child under the age of 5 years.)

The professional journal articles I have relied upon in the issuance of this Physician's Warranty of Vaccine Safety are itemized on Exhibit B , attached hereto, -- "Scientific Articles in Support of Physician's Warranty of Vaccine Safety."

The professional journal articles that I have read which contain opinions adverse to my opinion are itemized on Exhibit C , attached hereto, -- "Scientific Articles Contrary to Physician's Opinion of Vaccine Safety."

The reasons for my determining that the articles in Exhibit C were invalid are delineated in Attachment D , attached hereto, -- "Physician's Reasons for Determining the Invalidity of Adverse Scientific Opinions."

Hepatitis B

I understand that 60 percent of patients who are vaccinated for Hepatitis B will lose detectable antibodies to Hepatitis B within 12 years. I understand that in 1996 only 54 cases of Hepatitis B were reported to the CDC in the 0-1 year age group. I understand that in the VAERS, there were 1,080 total reports of adverse reactions from Hepatitis B vaccine in 1996 in the 0-1 year age group, with 47 deaths reported.

I understand that 50 percent of patients who contract Hepatitis B develop no symptoms after exposure. I understand that 30 percent will develop only flu-like symptoms and will have lifetime immunity. I understand that 20 percent will develop the symptoms of the disease, but that 95 percent will fully recover and have lifetime immunity.

I understand that 5 percent of the patients who are exposed to Hepatitis B will become chronic carriers of the disease. I understand that 75 percent of the chronic carriers will live with an asymptomatic infection and that only 25 percent of the chronic carriers will develop chronic liver disease or liver cancer, 10-30 years after the acute infection.

The following scientific studies have been performed to demonstrate the safety of the Hepatitis B vaccine in children under the age of 5 years.

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

In addition to the recommended vaccinations as protections against the above cited risk factors, I have recommended other non-vaccine measures to protect the health of my patient and have enumerated said non-vaccine measures on Exhibit D , attached hereto, "Non-vaccine Measures to Protect Against Risk Factors."

I am issuing this Physician's Warranty of Vaccine Safety in my professional capacity as the attending physician to (Patient's name) ________________________________.

Regardless of the legal entity under which I normally practice medicine, I am issuing this statement in both my business and individual capacities and hereby waive any statutory, Common Law, Constitutional, UCC, international treaty, and any other legal immunities from liability lawsuits in the instant case.

I issue this document of my own free will after consultation with competent legal counsel whose name is _____________________________, an attorney admitted to the Bar in the State of __________________ .



__________________________________ (Name of Attending Physician)

__________________________________ L.S. (Signature of Attending Physician)

Signed on this _______ day of ______________ A.D. ________

Witness: _______________________________ Date: ______________________

Notary Public: ___________________________ Date: ______________________