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Physician Warranty of Vaccine Safety

post #1 of 34
Thread Starter 

All the "informed consent forms" I was given when my children received their vaccines simply stated, "Adverse reactions are rare, and include fever , fussiness, and redness/soreness at injection site."

 

That was it.

 

Even if you go to the package insert, or to drugs.com, you'll find that it says, "Adverse reactions include..."  

 

Which means there are adverse reactions NOT LISTED that can happen.

 

Anyway, I found this Physician warranty form, and thought I'd post it.  I doubt there's any physician who WOULD sign it, but nonetheless, it makes a good point.

 

 

 

 Your Letterhead 

 

 

To:  (Physician or Health Care Professional's Name)

(Your Employer or Government Agency Name)

 

Re:  Personal Affidavit and Warranty of Vaccine Efficacy and Safety 

 

Dear Responsible Doctor or other Designated Health Care Professional,

If you will be administering a vaccination to me today, I will need you to complete the following form. Thank you.

 

Physician or Health Care Professional's Attestation and Warranty of  Vaccine Efficacy and Safety

I, (Physician or Health Care Professional's name, degree)____________________, ___________ am a (physician/health care) professional licensed to practice medicine in the State of ____________.
My State license number is _________________, and my DEA number is __________________. My medical specialty is _____________________________.

   
I do hereby state that I have advised my patient (Your Name), that in my professional opinion this patient should be given the vaccination(s), drug(s) or other (name of vaccination(s)/drug(s)/other) ________________________, manufacturer's name ________________________, serial number ___________________, 

batch number _____________________, expiry date____________________.

I have on this _________day of ___________________(month), A.D._________(year),
administered this vaccination/medication/drug AFTER advising the above named patient that there is no risk involved with this vaccination, medication, drug therapy or treatment to the good health of my patient whatsoever. Therefore, and because any potentially negative or adverse effects of said vaccine(s) are apparently (and contradictorily) no longer insurable as being too high a risk, I hereby agree, without reservation, that should this patient at any time suffer or develop any permanent condition deleterious or injurious to my patient's health as a result of this treatment, I will personally pay for any and all costs involved relating to the care and treatment necessary for this patient for the rest of (his/her) natural life. I further agree that if my earnings are insufficient to meet these costs, I will sell my home, my business and all of my material possessions and put those proceeds towards meeting the patient-involved expenses. Furthermore, as the fully authorized, designated and currently employed representative of (Your Employer Name or Government Agency), and acting in that capacity under personal penalty of perjury, who has been granted complete and unconditional authority to contractually bind (Your Employer Name or Government Agency), under full acceptance of commercial liability, I do hereby bind as legally liable (Your Employer Name or Government Agency) for the lifelong medical and private care of the patient as well as all financial hardship incurred by the patient as a result of said deleterious or injurious effects of said vaccine(s), should they occur.

 

 


Page 1 of 4 Initials of Responsible Physician or Designated Health Care Professional: __________

 

                                                                                                                                                                              I do hereby state that 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 (Your Name; age (??)), whom I have examined, I find that certain risk factors exist that justify the recommended vaccination(s).

Following is a list of said risk factors that the vaccination(s) will, without question, protect my patient from: 

                Risk Factor(s)     Vaccination(s):

   _______________________________________________________________________________

 

   _______________________________________________________________________________

 

   _______________________________________________________________________________

  

   _______________________________________________________________________________

 

   _______________________________________________________________________________
 

I am aware that vaccines typically contain many or all of the following substances:

aluminum hydroxide, human diploid cells,

hydrolized gelatin, (originating from aborted 

aluminum phosphate,   human fetal tissue),

ammonium sulfate, squalene,

amphotericin B,  latex,

animal tissues, hydrolized gelatin, 

pig blood, mercury (thimerosol),

horse blood, monosodium glutamate (MSG), 

rabbit brain, neomycin, neomycin sulfate, 

dog kidney, phenol red indicator, 

monkey kidney,  phenoxyethanol (antifreeze), 

chick embryo, potassium diphosphate,

chicken egg, potassium monophosphate, 

duck egg,  polymyxin B, polysorbate 20, 

calf (bovine) serum, polysorbate 80., 

betapropiolactone, porcine (pig) pancreatic, 

fetal bovine serum, hydrolysate of casein, 

formaldehyde, residual MRC5 proteins, 

formalin, gelatin,  sorbitol, sucrose, 

glycerol, tri(n)butylphosphate, VERO cells, 

sheep blood.             retroviruses and/or carcinogenic or other forms of infectious                 mycoplasmic agents

 

 

 

 

 

 

 

Page 2 of 4 Initials of Responsible Physician or Designated Health Care Professional: __________

 

 

Furthermore, and not withstanding my patient's religious objections and medical concerns regarding the possible inclusion of scripturally unclean and possibly diseased animal remains as well as aborted human fetal tissues contained within the vaccine(s) in apparent direct violation of  (Your Employer's Name or Government Agency) own ethical standards and corporate policy of No Harassment/Discrimination (page 58; paragraphs(s)1&2: “Associate Handbook”-example), as well as federal, state and international laws, treaties and conventions, or the extensive list of cautions and warnings of the very real possibility of severe adverse reactions as so listed on the vaccine manufacturer(s)' own package insert(s), or the high number of adverse reports against said vaccine(s) that have already been recorded worldwide, or the apparent complete absence of any verifiable and independent, peer reviewed, long term, double blind and placebo controlled in vivo studies confirming the safety and/or efficacy of said vaccine(s), or my patient's assertion that he/she has already been exposed to both this year's seasonal and Swine flu strains and has overcome them both with no difficulty or residual adverse effects whatsoever thereby having already been conferred long lasting and heightened immunity against said strains, and in spite of my patient's assertion of chemical sensitivity and/or allergies to numerous chemical and biological substrates, additives and adjuvants possibly contained within said vaccine(s) as well as the irrefutable fact that due to the proprietary nature of some ingredients, that those ingredients may not even be required to be listed on the package insert(s), thereby rendering as scientifically impossible a medically objective risk/benefit assessment on behalf of my patient, as well as my being totally unfamiliar with my patient's past medical history or unique and untested physiology, I nonetheless attest and warrant that these ingredients are effective and safe for injection or inhalation into the body of my patient. Reports to the contrary, such as reports that mercury thimerosol causes severe neurological and immunological damage, 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 give my personal assurance that the vaccine(s) I employ in my practice do not contain SV 40 or any other infectious agents and therefore pose no health risks to my patients whatsoever.

Furthermore, I hereby Attest and Warrant that the vaccine(s) I am recommending for the care of (Your Name) do not contain any cells 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 vaccine(s) I will use will contain no damaging contaminants. The steps taken are as follows:

____________________________________________________________________________________________________________________________________________________________________________________. 


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 vaccine(s) I am recommending are both effective and safe for administration to this patient, adverse reports notwithstanding.

 

I have now been made aware of the both the video from Sister Teresa Forcades, MD; PHD - “Bell Tolling for the Swine Flu” at: www.youtube.com/watch?v=61ySNSQTR-Q&feature=related, as well as the following quote by Dr. Anthony Morris, a distinguished virologist and former Chief Vaccine Officer at the U.S. Food and Drug Administration (FDA), who states that “There is no evidence that any influenza vaccine thus far developed is effective in preventing or mitigating any attack of influenza” and that “The producers of these vaccines know they are worthless, but they go on selling them anyway,” and hereby affirm that both doctors' assertions (as well as many others), regarding the vaccines' apparent lack of safety and efficacy are totally false and without merit.

The basis for my opinion is itemized on Exhibit A, attached hereto, "Physician or Health Care Professional's Basis for Professional Opinion of Vaccine Efficacy and Safety." (Please itemize each recommended vaccine separately along with the basis for arriving at the conclusion that the prescribed vaccine(s) are both effective and safe for administration to this patient).

The professional journal articles I have relied upon in the issuance of this Physician or Health Professional's Warranty of Vaccine Efficacy and Safety are itemized on Exhibit B, attached hereto, "Scientific Articles in Support of Physician or Health Care Professional's Warranty of Vaccine Efficacy and Safety." The professional journal articles that I have read which contain contradictory opinions to my own are itemized on Exhibit C,

 

Page 3 of 4             Initials of Responsible Physician or Designated Health Care Professional: __________

 

attached hereto, "Scientific Articles Contrary to Physician or Health Care Professional's Opinion of Vaccine Efficacy and Safety." The reasons for my determining that the articles in Exhibit C are invalid are delineated in

Attachment D , attached hereto, "Physician or Health Care Professional's Reasons for Determining the Invalidity of Adverse Scientific Opinions." I do therefore Attest and Warrant (and in spite of the overwhelming body of evidence to the contrary), that the vaccines that I am prescribing for my patient are hereby proven beyond question to be safe and effective for the condition(s) for which the said vaccine(s) are here being administered.

 

Regardless of the legal entity under which I normally practice medicine, I am issuing this statement in both my professional business or government capacity and as a private individual while hereby waiving any Statutory, Common, Equity, UCC, Maritime/Admiralty or Constitutional law, international treaty or 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 ___________________, as well as 

 

________________________, Supervisor, Department Head, President, CEO, or Company Owner

          (circle 1 or more titles) of (Your Employer or Government Agency). 

 

 

_________________________________,     _______________________________,

 

Signature of Attorney. Signature of: Supervisor, Department Head, President,          CEO or Company Owner

         

______________________________, 

 

Printed Name of Responsible Physician or Designated Health Care Professional.

 


______________________________,

 

Signature of Responsible Physician or Designated Health Care Professional.

 

 

____________________________,

 

Printed Name of Witness.

 

 

____________________________.

 

Signature of Witness

 

 

Subscribed and Sworn before Me on this_______day of ____________________, A.D.__________. 

 

 

Notary Public: _________________________________________, 

 

 

County: _________________, State:___________________.

 

 

My Commission Expires: ____________________________________.

 

 

Page 4 of 4 Initials of Responsible Physician or Designated Health Care Professional: __________

post #2 of 34

 

Quote:

Anyway, I found this Physician warranty form, and thought I'd post it.  I doubt there's any physician who WOULD sign it, but nonetheless, it makes a good point.

 

 

It does make a good point.  It tells the doctor that the patient is a litigious nutcase and needs to be fired from their practice ASAP.  

post #3 of 34

I think it's baiting and rude.  Who would go into a doctors office and hand them that?  Not all doctors are bad, can't you just put on your big girl panties and say you don't want vaccinations and leave it at that?

post #4 of 34

 

 

Quote:
" AFTER advising the above named patient that there is no risk involved with this vaccination, medication, drug therapy or treatment to the good health of my patient whatsoever."

Well, yeah, no doctor is going to sign that-- because it's untrue.  And any doctors KNOWS that it would be false to say that vaccines have "NO RISK"-- as in zero.  Vaccines don't have a 100% safety rate.  Neither does aspirin, or antibiotics, or any medication ever.

 

All a doctor will tell you is that you have a lower risk of harmful side effects from vaccination, than you would have if you caught the disease.

 

Seems easy to understand to me.

post #5 of 34
Thread Starter 
Quote:
Originally Posted by WildKingdom View Post

 

 

It does make a good point.  It tells the doctor that the patient is a litigious nutcase and needs to be fired from their practice ASAP.  



Why would that patient be a litigious nutcase when that patient is not asked but REQUIRED to sign a similar form if she refuses or even delays vaccines?  

 

That patient is also required to sign an "informed consent" form that says that she understands the risks involved with whatever vaccine she is being given.  I don't know about you, but I have a copy of the informed consent form our ped hands out; it states,

 

"Adverse reactions include swelling and redness at injection site, fever, and irritability."


Period.

 

I signed it.  Nowhere did it tell me that I would be holding a seizing infant an hour later, nor that my baby would be seizing for over 3 hours.

 

Now, I never sued anyone for that reaction.  My child recovered with a minimum of damage.  We are lucky, very lucky.

 

But there are an awful lot of pediatricians who expect parents to sign "informed consent" forms without giving them most of the pertinent information, and who expect parents who refuse or delay vaccines to sign a form stating that they are placing their lives and the lives of others at risk by doing so.

 

In all fairness, shouldn't those doctors also sign a form, stating that THEY have seen all the pertinent information (because the parent sure as heck has not), and that THEY understand the risk in giving vaccines that have resulted in thousands of severe adverse effects?  (I know, I'm ignoring the fact that physicians all have blanket immunity from liability regarding vaccine reactions anyway.  Your child could die from the vaccine, and you can't sue the doctor who gave it, even if the doctor gave it against your wishes, or even without your consent.)

post #6 of 34

While all that is certainly true, going to a doctor with a letter such as that is not the right way to go about it.  Instead you should be ready to ask the questions.  And decide what to do with the information. 

post #7 of 34
Thread Starter 
Quote:
Originally Posted by Imakcerka View Post

I think it's baiting and rude.  Who would go into a doctors office and hand them that?  Not all doctors are bad, can't you just put on your big girl panties and say you don't want vaccinations and leave it at that?


Unfortunately, there are a lot of cases where you can't leave it at that.

 

What about the parents who say that they don't want vaccinations, but the DOCTOR won't leave it at that?  

What about the doctors who make the parents sign a form saying that they are risking their child's life, and the life of others by refusing or delaying a vaccine?

What about the doctors who don't care what you sign, they refuse to treat your child unless they are caught up on all vaccines, regardless of previous reaction?  

What about the nurses who threaten/lie to the parents, telling them that their child will be unable to attend school, that their child will be taken by Children's Services if they don't get all their vaccines TODAY?  

What about the hospital nurses who vaccinate your baby without your consent and against your specific, written, doctor-approved instructions on your chart, while you are taking a shower 4 hours after delivering your baby? (That's what happened to my second baby.)

 

This isn't about panties, big or otherwise.

 

I am not suggesting that anyone should take this form and hand it to the doctor without any prior discussion. And I'm not saying all doctors are bad, either.  

 

Where do we draw the line?  At what point is it okay for the doctor to force parents to sign "informed consent" forms that leave out most of the pertinent information (so it really isn't "informed consent," is it?), but not okay for the patient to ask for something similar from the doctor?

 

My understanding is that this form is not meant to be handed to a doctor to sign, but to make a point.  And that point is, neither doctors nor parents are fully informed as to the risks involved with today's vaccines.

post #8 of 34

Exactly.  However would you hand it to your doctor?  No I do not think it's okay for any of those things to happen.  Fortunately I had a military doctor explain why he felt the vaccines were not necessarily safe.   While I have made decisions based on research and the help of what I consider a very good ped doctor.  Others have to find a way to work through the system and get things done they way they want them to be done.  Of course there is a lot of bullying going on, but know your rights and the laws of your state are very important.  Not allowing yourself to be bullied and making sure you are heard are very important.  Handing a semi sarcastic letter to your doctor to show how you feel... could simply be stated in words. 

 

If you can't speak then by all means use the letter. 

post #9 of 34
Thread Starter 
Quote:
Originally Posted by Imakcerka View Post

While all that is certainly true, going to a doctor with a letter such as that is not the right way to go about it.  Instead you should be ready to ask the questions.  And decide what to do with the information. 



I agree.  But isn't there a point at which doctors SHOULD be given this information (not necessarily by the parent 5 minutes before the needle is uncapped), just so the doctor can see what the issues really are?

I have a friend who is a pediatrician, whose first comment about vaccines to me was, "but there are way fewer antigens in today's vaccines than there were 30 years ago!"

 

This was 3 years ago. She had no idea that some vaccines still contain thimerosal--she thought they'd been "removed" from all vaccines in 1999.  She had no idea that they contain aluminum.  She had no idea that 1297 cases of vaccine-induced brain damage have been admitted and compensated by the US government.  She had no idea that vaccines can cause lupus.

 

She is a kind, caring, intelligent doctor, and an excellent diagnostician.  But she had no idea of the harm that vaccines can cause, because that wasn't in her training.  And even though she is an excellent diagnostician, she did not recognize vaccine reactions when she saw them, because that wasn't how she was trained.  She was trained to believe that babies sometimes get severe rashes for unknown reasons, and that one occurring 24 hours after a vaccine is a fluke, that seizures occuring within 3 weeks (or 3 hours, for that matter) of a vaccine are just a fluke, that a baby's 2-day loss of consciousness following vaccines is not a serious reaction as long as there are enough wet diapers, and that a toddler's immediate loss of skills 24 hours after vaccination is the parents' imagination, couldn't possibly be connected with the vaccine.

 

So, for those of us whose children DID have severe vaccine reactions--at what point is it up to us to try to educate the doctors?  Ever?  Never?  If it isn't up to us, who is it up to? And if it IS up to us--how do you suggest we go about it? 

 

 

post #10 of 34
Thread Starter 
Quote:
Originally Posted by Kelly1101 View Post

 

 

Well, yeah, no doctor is going to sign that-- because it's untrue.  And any doctors KNOWS that it would be false to say that vaccines have "NO RISK"-- as in zero.  Vaccines don't have a 100% safety rate.  Neither does aspirin, or antibiotics, or any medication ever.

 

All a doctor will tell you is that you have a lower risk of harmful side effects from vaccination, than you would have if you caught the disease.

 

Seems easy to understand to me.


I think that was true with the vaccine schedule from 30 years ago.


I don't think it's true now.

 

I also think the doctors have absolutely no clue how many people do have serious reactions from vaccines. How could they?  Only 1-10% of those serious reactions ever get reported, because the reporting system is VOLUNTARY. And doctors aren't trained to recognize reactions.

 

How many doctors are aware that vaccines can cause seizures up to 3 weeks following vaccination?  Mine didn't even recognize that vaccines could cause a seizure 1 hour post-vaccination!  But if you search the Merck manual, you find that the manufacturer knows this.  Why don't the doctors?

 

post #11 of 34

I understand your annoyance - truly I do.

 

It is funny - those ads on tv for drugs are so long and scary listing all of the possible side effects, but vaccine pamphlets (last I saw of one and it has been a few years) say so little.  

 

The whole fussiness and sore arm thing is so annoying!  As if anyone cares about that!  List the serious reactions and how likely they are.

 

I must say this patronising give patients information on "a need to know basis" does not only extend to vaccines.  My youngest was in the hospital with a serious infection.  I only learned after the administration of antibiotics that the antibiotics in question could cause deafness.  I would have liked to discuss the different antibiotics available, their risk factors and success rate, etc.  i may have gone for the antibiotics they chose, but I would have liked to make an informed choice.  

 

In some ways we are lucky with vaccines - we have the opportunity to research them ahead of time.

 

 

 

Kathy

post #12 of 34

.  


Edited by member234098 - 5/27/12 at 3:43pm
post #13 of 34
Thread Starter 

What is SBS?

post #14 of 34


Edited by member234098 - 5/27/12 at 3:42pm
post #15 of 34
post #16 of 34

The form is rather antagonistic.

 

post #17 of 34
Thread Starter 
Quote:
Originally Posted by Jugs View Post

The form is rather antagonistic.

 



You are right. It is.

 

I think it was written by parents of severely vaccine-injured children, who, like myself, had been given the "informed consent" form that only mentions the mild risks ("Risks may include redness, swelling, slight fever, and irritability"), with no mention whatsoever of any other risks.

 

 

post #18 of 34

Do vaccines really contain horse blood, rabbit brain and fetal tissue? Isn't that illegal? If this is true I am very shocked. I mean as far as human fetal tissue I can't even imagine. Cows get mad cow from eating brain tissues from their own kind and it's legal to inject fetal tissue into humans?

post #19 of 34
Quote:
Originally Posted by tatsu15 View Post

Do vaccines really contain horse blood, rabbit brain and fetal tissue? Isn't that illegal? If this is true I am very shocked. I mean as far as human fetal tissue I can't even imagine. Cows get mad cow from eating brain tissues from their own kind and it's legal to inject fetal tissue into humans?



 

No. No, they don't. They also don't contain antifreeze, monkey brains, eye of newt or toe of frog. 

 

Many, many things in this form are untrue. 

post #20 of 34
Quote:
Originally Posted by Taximom5 View Post



You are right. It is.

 

I think it was written by parents of severely vaccine-injured children, who, like myself, had been given the "informed consent" form that only mentions the mild risks ("Risks may include redness, swelling, slight fever, and irritability"), with no mention whatsoever of any other risks.

 

 


 

The VIS' presented at the time of vaccination (as required by law) are more comprehensive than that. They list possible mild, moderate and severe reactions, contraindications, as well as how to report a serious reaction.

 

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