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.
Date of birth of the vaccinated 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
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
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
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.
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)?
Please specify when you selected "allergies" (300 chars left)
Please describe the general state of health of your vaccinated child*
Additional information you want to give
Re-Captcha - Please Check the box
reset
submit
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