Physician’s Warranty of Vaccine Safety
I (Physician’s name, degree)___________________
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
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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®)
• 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
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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 thimerosal 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” or Human Diploid Tissue).
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: __________________________
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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% 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% of patients who contract Hepatitis B develop no symptoms after exposure.
I understand that 30% will develop only flu-like symptoms and will have lifetime immunity.
I understand that 20% will develop the symptoms of the disease, but that 95% will fully recover and have lifetime immunity.
I understand that 5% of the patients who are exposed to Hepatitis B will become chronic carriers of the disease.
I understand that 75% of the chronic carriers will live with an asymptomatic infection and that only 25% 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.
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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) __________________________
I issue this document of my own free will after consultation with competent legal counsel whose name is __________________________
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Signed on this _______ day of ______________ A.D. ________
Witness: __________________________
Notary Public: __________________________
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