Re: Can anyone help me find this?

[Guest guest]

Hi Peggy,

What about something like this:

Physician's Warranty of Vaccine Safety

(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:

_____________________________________________________ _________________

_____________________________________________________ _________________

_____________________________________________________ _________________

_____________________________________________________ _________________

_____________________________________________________ _________________

_____________________________________________________ _________________

_____________________________________________________ _________________

I am aware that vaccines typically contain many of the following

ingredients:

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 Thermosol

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

Sucrose

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. Reports to the contrary, such as reports

that mercury thermosol causes severe neurological and immunological

damage, are not credible. I am aware that some vaccines have been

found to have been contained with Simian Virus 40 (SV-40) and that

SV-40 is casually linked by some researchers to non-Hodgkin's

lymphoma and mesotheliomas in humans as well as in experimental animals.

I hereby give my assurance that the vaccines I employ in my practice

do not contain SV-40 or any other live viruses. (Alternately, I

hereby give my assurance that said SV-40 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 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 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% 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 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 y 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 herby

waive any statutory, Common Law, Constitutional, UCC, international

treaty, and any other legal communities 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:

________________________

> I have a friend that is bringing her premie for the 2 mos check up.

> She

> does not want to vaccinate. She mentioned this to the Peds

> receiptionist and was told she would have to sign a waiver letter. I

> told her DO NOT sign this form. Its an admission of medical neglect. I

> cannot remember where but I saw a really great waiver letter to

> give to

> a pediatrician. I have searched google over and over and cannot find

> it. Anyone know where I can find it so I can send it to her?

>

> Peggy

>

>

> ------------------------------------

>

>

[Guest guest]

You know, I thought the one that I saw was very similar to this one

but from the parents point of view. It states something to the effect

that I have researched Blah, Blah, lists all he ingredients like this

letter does, but the parent signs it and it goes into the file.

Peggy

>

> > I have a friend that is bringing her premie for the 2 mos check

up.

> > She

> > does not want to vaccinate. She mentioned this to the Peds

> > receiptionist and was told she would have to sign a waiver

letter. I

> > told her DO NOT sign this form. Its an admission of medical

neglect. I

> > cannot remember where but I saw a really great waiver letter to

> > give to

> > a pediatrician. I have searched google over and over and cannot

find

> > it. Anyone know where I can find it so I can send it to her?

> >

> > Peggy

> >

> >

> > ------------------------------------

> >

> >

[Guest guest]

My employer tried to get me to sign a form about not getting the flu

shot. It went into my desk, never to be seen again.

I was actually in a flu shot meeting and asked if these declination

forms were tallied and/or reported to anyone, CDC, etc.

Nope. Sat in a pile.

I don't know about other places,

CGF

>

> I have a friend that is bringing her premie for the 2 mos check up.

She

> does not want to vaccinate. She mentioned this to the Peds

> receiptionist and was told she would have to sign a waiver letter.

I

> told her DO NOT sign this form. Its an admission of medical

neglect. I

> cannot remember where but I saw a really great waiver letter to

give to

> a pediatrician. I have searched google over and over and cannot

find

> it. Anyone know where I can find it so I can send it to her?

>

> Peggy

>