State of health of unvaccinated children/persons - Estado de salud de los niños no vacunados / personas

For statistical evaluation of the state of health of entirely unvaccinated 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.

Before filling out the survey, please check the hospital birthing record, whether your kid  got hepatitis B vaccination at birth in hospital.

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

If you have vaccinated children please go to the questionnaire for vaccinated children.

Para la evaluación estadística del estado de salud de todo los niños no vacunados / personas le rogamos que rellene el siguiente formulario. Los datos se publicarán de forma anónima y manejados con absoluta confidencialidad. Los resultados nos ayudan a obtener información precisa sobre la salud de los niños no vacunados. Antes de llenar la encuesta, por favor, compruebe el registro de nacimiento del hospital, si su niño tiene vacunación contra la hepatitis B administrada al nacer en el hospital. Si usted tiene varios hijos, por favor, rellene un formulario para cada niño.Si usted tiene niños vacunados, por favor, vaya al cuestionario para los niños vacunados.

Name/Initials of the entirely unvaccinated child

Date of birth of the unvaccinated child ...

Age group (present) 0-2 years 3-4 years 5-6 years 7-8 years 9-10 years 11-12 years 13-14 years 15-16 years 17-18 years 19- years and older

Gender male female *

Country United States(USA) Canada United Kingdom Australia New Zealand --- Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Espana Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Republic of Korea (South) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Russian Federation Rwanda Saint Barthelemy Saint Kitts and Nevis Saint Lucia Saint Martin Saint Vincent and the Grenadines Samoa (Independent) San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka St. Helena St. Pierre and Miquelon Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States(USA) United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wales Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe

Email (Please enter a valid email address, in case of queries. Please subscribe to our newsletter,if you want to take part in further surveys concerning your unvaccinated child) *

Repeat your email address please *

Are you happy that you did/do not vaccinate your children? Yes No

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

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

Preferred treatment homeopathy naturopathic med. conventional med. other

Please specify, when you selected "other"

Was your child breastfed and how long(exclusive breastfeeding)? 0 to 4 weeks 5 weeks - 3 months 4 months - 6 months 7 months and longer no

Why is your child not vaccinated?(For multiple answers hold down Strg/Ctrl/Command and select) Vaccine damage/reaction of siblings and friends Intensive preoccupation with vaccine topic Conviction of ineffectiveness of vaccines Through fear of side effects Due to preexisting conditions of the child Concerns about ingredients in vaccines religious/philosophical belief other

Please specify, when you selected "other"

Describe the general state of health of your child/Additional information you want to give. If you want to share your story (http://www.vaccineinjury.info/results-unvaccinated/personal-stories.html), please mention it particularly

Where did you hear about the survey?

Please enter the letters/numbers of the picture

Thank you very much for your report!

The results of this survey can be seen here: http://www.vaccineinjury.info/vaccinations-in-general/health-unvaccinated-children/survey-results.html

Do you have vaccinated children?

Due to many requests we are doing a direct comparison with vaccinated children now. If you have vaccinated children please go to the questionnaire for the state of health of vaccinated children.

Do you want to support further surveys?

Please scroll down  and subscribe to our Newsletter(on the left site). We would like to continue our research (some further questionnaires regarding vaccine preventable diseases) and want to be sure that we have your correct email address (the newsletter registry allows it that you have to verify your email address)

Vaccine damage report

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 for your support

Andreas Bachmair