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State of health of unvaccinated children

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Invaluable frequently asked questions and answers from a licensed American attorney.

State of health of vaccinated children/persons (Gesundheitszustand geimpfter Kinder)

!If you have entirely unvaccinated children please go the questionnaire for unvaccinated children.!

For statistical evaluation of the state of health of vaccinated children/persons we request you to fill out the following form. The data will be published anonymously and handled with utmost confidentiality. The results help us to acquire accurate information about the health of unvaccinated children compared to the state of health of vaccinated children.

If you have several children, please fill in a form for each child.

Analog zu unserer Umfrage zum Gesundheitszustand ungeimpfter Kinder führen wir nun eine Umfrage zum Gesundheitszustand geimpfter Kinder durch. Die deutschen Übersetzungen finden Sie, wenn Sie mit der Maus über das blaue "i" gehen. Die offenen Fragen können SIe auf deutsch beantworten.

Name/Initials of the vaccinated child

Date of birth of the vaccinated child

Age group (present)

Gender male female *

Number of brothers and sisters 0 1 2 3 4 5 6 7 8 9 10

How many of brothers and sisters are entirely unvaccinated? 0 1 2 3 4 5 6 7 8 9 10

Place of residence

Country

Email (Please enter a valid email address, in case of queries) *

Repeat your email address please *

Preferred treatment homeopathy naturopathic med. conventional med. other

Please specify, when you selected "other"

Was your child breastfed and how long(exclusive breastfeeding)?

Which vaccines were given? Anthrax
BCG
Diphtheria, Tetanus
Diphtheria, Tetanus, Polio
Diphtheria,Tetanus, Pertussis
Diphtheria,Tetanus, Pertussis, HiB
Diphtheria,Tetanus, Pertussis , Poliovirus
Diphtheria, Tetanus , Pertussis, Poliovirus and Haemophilus b
Diphtheria, Tetanus , Pertussis, Poliovirus, Haemophilus b, Hepatitis B
Haemophilus b
Haemophilus b & Hepatitis B
Hepatitis A
Hepatitis A + B
Hepatitis B
Human Papillomavirus, HPV
Influenza
Influenza, H1N1
Japanese Encephalitis
Measles
Measles, Mumps
Measles, Mumps, and Rubella
Measles, Mumps, Rubella and Varicella
Meningococcal Vaccine
Mumps
Plague
Pneumococcal Vaccine
Poliovirus
Rabies
Rotavirus
Rubella
Smallpox
TBE
Tetanus
Typhoid
Varicella (Chickenpox)
Yellow Fever
Zoster(Shingles) Vaccine
other

Which Vaccines were given?

Please mark every vaccine your child or you received / Bitte markieren Sie jede Impfung, die gegeben wurde mit Yes=ja.

Anthrax Yes No

BCG Yes No

Diphtheria, Tetanus Yes No

Diphtheria, Tetanus, Polio Yes No

Diphtheria,Tetanus, Pertussis Yes No

Diphtheria,Tetanus, Pertussis, HiB Yes No

Diphtheria,Tetanus, Pertussis , Poliovirus Yes No

Diphtheria,Tetanus, Pertussis, Poliovirus ,Hepatitis B Yes No

Diphtheria, Tetanus , Pertussis, Poliovirus and Haemophilus b (HIb) Yes No

Diphtheria, Tetanus , Pertussis, Poliovirus, Haemophilus b(HIb), Hepatitis B Yes No

Haemophilus b Yes No

Haemophilus b & Hepatitis B Yes No

Hepatitis A Yes No

Hepatitis A + B Yes No

Hepatitis B Yes No

Human Papillomavirus, HPV Yes No

Influenza Yes No

Measles Yes No

Measles, Mumps Yes No

Measles, Mumps, and Rubella Yes No

Measles, Mumps, Rubella and Varicella Yes No

Meningococcal Vaccine Yes No

Mumps Yes No

Plague Yes No

Pneumococcal Vaccine Yes No

Poliovirus Yes No

Rabies Yes No

Rotavirus Yes No

Rubella Yes No

Smallpox Yes No

TBE (Tick born encephalitis) Yes No

Tetanus Yes No

Typhoid Yes No

Varicella(Chickenpox) Yes No

Yellow Fever Yes No

Zoster(Shingles) Vaccine Yes No

other Yes No

Product names of the vaccines

How many vaccinations(shots) altogether (polyvalent vaccines count as one!)- Please check even if you do not exactly know the quantity.. 1-3
4-6
7-9
10-15
16-20
21-30
31-40
41-50
>50

Is the child still getting vaccinated? Yes No

Are you glad that your child is vaccinated? Yes No

Does your child suffer from any of the following illnesses or symptoms? (Please answer every question with yes, no or rarely) Leidet Ihr Kind an den folgenden Erkrankungen (Bitte jede Frage beantworten mit Ja=yes, nein=no oder selten=rarely)?

Sleeping problems Yes No rarely

Crybaby / Excessive crying as a baby Yes No

Difficulty in concentration Yes No rarely

Attention Deficit disorder (ADD) Yes No

Hyperactivity Yes No

Autism Yes No

Other mental disorders

Migraine or headaches Yes No rarely

Scoliosis Yes No

Allergies Yes No

Hayfever or chronic rhinitis Yes No

Asthma or chronic bronchitis Yes No

Neurodermatitis or other eczema Yes No

Dermatophytes (fungal infection of the skin) Yes No rarely

Middle ear infections, otitis media Yes No rarely

Sinusitis Yes No rarely

Nasal polyps Yes No

Herpes Yes No rarely

Warts Yes No

Fine motor skills problems Yes No

Growth disturbance or pains Yes No rarely

Dentification problems Yes No rarely

Thyroid disease Yes No

Diabetes mellitus Type I Yes No

Diabetes mellitus Type II Yes No

Epilepsy and/or other seizures Yes No rarely

Neurological disorders Yes No

Autoimmune disorders Yes No

Other illnesses

Please describe the general state of health of your vaccinated child *

Additional information you want to give

Where did you hear about the survey?(please provide a detailed link)

Please enter the letters/numbers of the picture (SPAM Protection).Not case-sensitive.

Thank you very much for your report!

If you want to be informed about the results of the survey, please subscribe to our newsletter. As soon as the results are published you will get a message in our newsletter.

Vaccine damage

In case you have a vaccine damage/injury in your family, I would appreciate if you could report that case. It is important to let other people know, what can happen after vaccinations. The data will be published anonymously and handled with utmost confidentiality. Please go to our report form.

Thank you

Andreas Bachmair

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