PHYSICIAN’S WARRANTY OF VACCINE SAFETY I (Physician’s name, - TopicsExpress

PHYSICIAN’S WARRANTY OF VACCINE SAFETY I (Physician’s name, degree)_______________, _____ am a physician licensed to practice medicine in the State/Province of _________. My State/Provincial 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 __________________________ I am aware that vaccines may contain many of the following chemicals, excipients, preservatives and fillers: * aluminum hydroxide * aluminum phosphate * ammonium sulfate * amphotericin B * animal tissues: pig blood, horse blood, rabbit brain, * arginine hydrochloride * dog kidney, monkey kidney, * dibasic potassium phosphate * chick embryo, chicken egg, duck egg * calf (bovine) serum * betapropiolactone * fetal bovine serum * formaldehyde * formalin * gelatin * gentamicin sulfate * glycerol * human diploid cells (originating from human aborted fetal tissue) * hydrocortisone * hydrolized gelatin * mercury thimerosol (thimerosal, Merthiolate(r)) * monosodium glutamate (MSG) * monobasic potassium phosphate * neomycin * neomycin sulfate * nonylphenol ethoxylate * octylphenol ethoxylate * octoxynol 10 * phenol red indicator * phenoxyethanol (antifreeze) * potassium chloride * potassium diphosphate * potassium monophosphate * polymyxin B * polysorbate 20 * polysorbate 80 * porcine (pig) pancreatic hydrolysate of casein * residual MRC5 proteins * sodium deoxycholate * sorbitol * thimerosal * 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 thimerosal causes severe neurological and immunological damage, and find that they are not credible.

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