Give This To Your Doctor to Sign When You Go For A Vaccination: Doctor’s Warranty of Vaccine Safety

Doctor’s Warranty of Vaccine Safety

I (Doctor’s name, degree/s)_________________________, _____ am a medical practitioner licensed to practice medicine in New Zealand. My medical speciality 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:

*         Aluminium hydroxide

*         Aluminium phosphate

*         Ammonium sulfate

*         Amphotericin B

*         Animal tissues: pig blood, horse blood, rabbit brain

*         Dog kidney, monkey kidney,

*        Calcium phosphate.

*        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 (Thimerosal which is 49.6% mercury)

*         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 cells

and hereby warrant that these ingredients are safe for injection into the body of my patient.  I have thoroughly researched reports to the contrary, such as the reports that Thimerosal causes severe neurological damage, autism and Alzheimer’s disease and that formalin, which is used in the manufacture of over half of all vaccines, causes chemical damage to vaccine proteins and creates reactive chemical groups called carbonyls which can mean that the immune system overreacts once infection occurs and attacks the body in a damaging way.   Although I am aware of these reports, I do not find any of them credible.

I am aware that Dr Maurice Hilleman of Merck stated that Merck knowingly distributed millions of vials of polio vaccine that were contaminated with Simian Virus 40 (SV40) [1] and that SV40 is causally linked by some researchers to non-Hodgkin”s lymphoma and mesotheliomas in humans as well as in experimental animals, [2]. I hereby warrant that the vaccines I employ in my practice do not contain SV40 or any other live viruses. (Alternately, I hereby warrant that said SV40 virus or other viruses pose no substantive risk to my patient).

Gardasil Vaccine

I am that the vaccine may lead to an INCREASE in precancerous lesions in women who already have relevant HPV types and  I am aware that Judicial Watch has uncovered FDA reports under the Freedom of Information Act which show that Gardasil led to an increase in the incidence of precancerous lesions by 44.6% in women who had relevant HPV types, [3].   I am aware that by October 2008, over 10,000 adverse reactions, including 27 deaths had been reported to the Vaccine Adverse Event Reporting System about Gardasil.  I am aware that cervical cancer usually develops in the late 20s to mid 30s and the protection period of Gardasil is estimated to be 5 years, which means that if my patient gets a first set of shots when she is 10 years old, she will need at least 2-4 additional booster shots to make it through her 30s and in so doing expose herself to the potential side effects of Gardasil over and over again.

I have read the report from Merck which mentions Gardasil was shown to reduce pre-cancers by only 12.2% to 16.5% in the general population and know that my patient will still need to have regular smear tests after she has been vaccinated.   I have read information regarding Gardasil thoroughly and do not regard the reports that it causes harm as credible and deem it safe and worthwhile to administer it to my patient.

Flu Vaccine

I am aware that most flu shots contain mercury and I have thoroughly researched the reports which indicate mercury is  highly neurotoxic.   I am aware that Hugh Fudenberg, MD, an immunogeneticist with nearly 850 papers published in peer review journals, has reported that if an individual had 5 consecutive flu shots between 1970 and 1980 (the years studied), his/her chances of getting Alzheimer’s Disease is 10 times higher than if they had zero, one, or two shots, [4]. I am aware of the reports that flu vaccines were deliberately contaminated with the deadly avian flu virus and distributed to 18 countries by the American company Baxter and that this was believed to be part of a plan to provoke a pandemic, [5].  I am also aware that flu shots do not necessarily protect people against getting the flu, but regard it as worthwhile administering a mercury-containing form of this vaccine to my patient.

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, — “Doctor’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 Doctor”s Warranty of Vaccine Safety are itemized on Exhibit B , attached hereto, — “Scientific Articles in Support of Doctor’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 Doctor’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, — “Doctor’s Reasons for Determining the Invalidity of Adverse Scientific Opinions.”

Hepatitis B Vaccine

I understand that 60 percent 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 percent of patients who contract Hepatitis B develop no symptoms after exposure. I understand that 30 percent will develop only flu-like symptoms and will have lifetime immunity. I understand that 20 percent will develop the symptoms of the disease, but that 95 percent will fully recover and have lifetime immunity.

I understand that 5 percent of the patients who are exposed to Hepatitis B will become chronic carriers of the disease. I understand that 75 percent of the chronic carriers will live with an asymptomatic infection and that only 25 percent 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.



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 Doctor’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 hereby waive any legal immunities 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 _____________________________.

__________________________________ (Name of Attending Doctor)

________________________________ (Signature of Attending Doctor)

Signed on this _______ day of ______________ A.D. ________

Witness: _______________________________  Date: _______

Notary Public: __________________________   Date: _______


1.      Interview with Dr Maurice Hilleman of Merck at

2.  SV40 is being found in human tumours.  See: SV40 Cancer Articles

3.      Judicial Watch Report On the Gardasil Vaccine. See this first 6 pages here.

The full report is here:

4. Hugh Fudenberg, MD, is Founder and Director of Research, Neurolmmuno Therapeutic Research Foundation. Information from Dr. Hugh Fudenberg came from transcribed notes of Dr. Fudenberg’s speech at the NVIC International Vaccine Conference, Arlington, VA, US.  September, 1997. Quoted with permission.

5. ‘Accidental’ Contamination of Vaccine with Live Avian Flu Virus Virtually Impossible

Clare Swinney

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