Guest guest Posted February 15, 2006 Report Share Posted February 15, 2006 Dear friends, I have forwarded this to you as you have a child or children affected by autism. I was told that we need atleast 100 parents documenting this information for next week's testimony before the house here in land for our Mercury-Free vaccine bill. You do not have to reside in land and no last names are to be filled in. Can you please help by filling this document out and returning it either via fax or email? Thank you everyone as we want to make land the seventh state to have Mercury-Free vaccines...Please send this far and wide so we can have way over a hundred responses. G. ---------------------------------------------------------------------- ------------------------- Thanks to all who have sent responses...we still need more! Dr. Arnold Brenner, a leading DAN! Practitioner in land is requesting information from the mothers of Mercury injured children. The statistics from this informal survey may be used in our land legislative presentation. Your name and the last name of the child are not necessary. Thank you. Child's First Name_________________________________ Child's Date of Birth_______________________________ Male/Female_____________________________________ 1) Did something seem wrong with your child as soon as you brought him/her home after delivery? Yes__________ No__________ 2) Did you receive Rhogam immuglobilins during or after delivery? If so, how many and when? _________________________________________________________________ 3) Did you receive patocin for encouraging labor? ______________________________ 4) Did you receive the epidural for pain during labor and delivery? ________________ 5) Did you receive any vaccinations during pregnancy? If so, which ones? ___________ _____________________________________Did you breast feed? _________________ 6) Did your receive MMR before, during or after delivery? _______________________ Did you breast feed? ______________________________________________________ 7) Did your child receive vaccinations in the hospital when you delivered? __________ Which vaccinations? ___________________________________________________ How many? ___________________________________________________________ 8) How many micrograms of mercury your child has received in their vaccine schedule? ____________________________________________________________ 9) Did you receive any vaccinations before pregnancy, such as vaccinations for college or your job? ___________How many? _______________________________________ Which ones? __________________________________________________________ 10) How soon after receiving vaccinations did you become pregnant? _______________ 11) When your child becomes ill or has a temperature, does your child become more typical? _________ How so? ____________________________________________ ______________________________________________________________________ Thank you for your response. Your response may be emailed to mom4kidsnow@... (email address will be deleted) or you may fax your response to . Mike and Elaine Dow polis, MD Quote Link to comment Share on other sites More sharing options...
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