Physicians Warranty Of Vaccine Safety

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Physician's Warranty of Vaccine Safety
I (Physician's name, degree)_________________________, _____ am a physician licensed to
practice medicine in the State/Province of ________________, in the country of
_________________. My State/Province license number is _______________ , and (if the USA)
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 ___________________________________________
Risk Factor ____________________________________________
Vaccination ___________________________________________
Risk Factor ____________________________________________
Vaccination ___________________________________________
Risk Factor ____________________________________________
Vaccination ___________________________________________
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(r))
* monosodium glutamate (MSG)
* neomycin
* neomycin sulfate
* phenol red indicator
* phenoxyethanol (antifreeze)

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