#13 NOTE TO EMPLOYER: As your employee, I am requesting that you review this document,
provide the requisite information, and sign the form, in regards to your requirement that
employees get a Covid- 19 emergency use authorization (EUA) investigational vaccine.
1) If I agree to receive an EUA Covid-19 injection, does my employee health insurance plan
provide complete coverage should I experience an adverse event, or even death?
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2) As an employee, does my life insurance policy provide any coverage in the event that I die
from receiving an EUA Covid-19 injection?
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3) As an employee, will you be providing Workers’ Compensation, disability insurance, or
other resources if I have an adverse event to an EUA Covid-19 injection and am unable to come
to work for days, weeks, or months, or if I am disabled for life?
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4) The Food and Drug Administration (FDA) requires that EUA vaccine recipients be provided
with certain vaccine-specific information to help them make an informed decision about
vaccination.
8 The EUA fact sheets that must be provided are specific to each authorized Covid19 injection and are developed by the manufacturers of the injections (Pfizer/BioNTech,
Moderna, Oxford/AstraZeneca, and the Johnson & Johnson subsidiary Janssen). The fact sheets
must provide the most current and up-to-date information the injections, and vaccine
recipients must also receive information about adverse events. Have you read, understood, and
provided me (and all other employees) with these fact sheets and with current information on
adverse events so that I/we can make an educated decision?
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5) Have you reviewed the available databases of material adverse events reported to date for
people who have received Covid-19 injections?9,10,11,12 Potential and reported adverse events
include death, anaphylaxis, neurological disorders, autoimmune disorders, other long-term
chronic diseases, blindness and deafness, infertility, fetal damage, miscarriage, and stillbirth.
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6) The FDA’s guidance13 on emergency use authorization of medical products requires the FDA
to “ensure that recipients are informed to the extent practicable given the applicable
circumstances... [t]hat they have the opon to accept or refuse the EUA product....” Are you
aware of this statement? Have you informed all employees that they have the opon to refuse?
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7) With respect to the emergency use of an unapproved product, the Federal Food, Drug and
Cosmetic Act, Title 21 U.S.C. 360bbb-3(e)(1)(A)(ii)(I-III)14 reiterates that individuals be informed
of “the opon to accept or refuse administration of the product, [and] of the consequences, if
any, of refusing administration of the product, and of the alternatives to the product that are
available and of their benefits and risks.” If EUA Covid-19 investigational vaccines are ever
approved by the FDA, state legislation would be required to allow companies to mandate the
Covid-19 injections. Are you aware of these facts?
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8) EUA products are unapproved, unlicensed, and experimental. Under the Nuremberg Code—
the foundation of ethical medicine—no one may be coerced to participate in a medical
experiment. The individual’s consent is absolutely essential. No court has ever upheld a
mandate for an EUA vaccine. In Doe #1 v. Rumsfeld, 297 F. Supp. 2d 119 (2003)15, a federal
court held that the U.S. military could not mandate EUA vaccines for soldiers: “...[T]he United
States cannot demand that members of the armed forces also serve as guinea pigs for
experimental drugs” (Id. at 135). Are you aware of this?
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9) The United States Code of Federal Regulations16 and the FDA require the informed consent of
human subjects for medical research. The EUA Covid-19 injections are unapproved, unlicensed,
investigational vaccines that are still in their experimental stage. It is unlawful to conduct
medical research on a human being, even in the event of an emergency, unless steps are taken
to secure the informed consent of all participants. Are you aware of this?
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10) According to Federal Trade Commission (FTC) Guidelines17 and the FTC’s “Truth In
Advertising,”18 promotional material—and especially material involving health-related
products—cannot mislead consumers, omit important information, or express claims. All of this
falls under the rubric of “deceptive advertising” (whereby a company is providing or endorsing
a product), whether presented in the form of an ad, on a website, through email, on a poster,
or in the mail. For example, statements such as “all employees are required to get the Covid-19
vaccine to make the workspace safe” or “it’s safe and effective” leave out critical information.
Critical information includes the facts that Covid-19 injections are unapproved EUA vaccines
that “may” or “may not” prevent Covid, won’t necessarily make the workspace safer, and could
in fact cause harm. Not providing links or attachments of the manufacturers’ fact sheets and
current information on adverse events is omitting safety information. Are you aware of this?
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11) Since the Covid lockdowns began over one year ago, there have been over 178 reported
breaches of unsecured protected health information (PHI), incidents investigated by the Office
for Civil Rights (OCR). These breaches exposed millions of people’s personal health information.
Although many of these incidents were attributed to hacking, some of the breaches to PHI fell
directly under the 1996 Health Insurance Portability and Accountability Act (HIPAA), such as
sharing a patient’s or person’s information with an unauthorized individual or incorrectly
handling PHI.19 Can you please explain your obligations to me, under HIPAA law, and how you
are going to protect my personal information - both with respect to your requirement that I
receive this injection?
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12) Whereas pharmaceutical companies that manufacture EUA vaccines have been protected
from liability related to injuries or deaths caused by experimental agents since the PREP Act1
was enacted in 2005, companies and all other institutions or individuals who mandate
experimental vaccines on any human being are not protected from liability. Are you aware
that you do not enjoy such liability protection?
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13) Are you aware that employees could lodge a civil suit against you should they suffer an
adverse event, death, or termination from their place of employment?
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As the legally authorized officer of the employer/company, I have read all of the above
information, have provided my employees with all of the information that the FDA requires be
provided to recipients of the Covid-19 injections, and do hereby agree to assume 100% financial
responsibility for covering any and all expenses from adverse events, including death, through
insurance coverage or directly. In addition, I affirm that the employee will not be subjected to
the loss of their job should they decline to receive a Covid-19 injection.
_______________________________________________ Authorized officer of company requiring injection
_______________________________________________ Employee
_______________________________________________ Witness
________________________________ ____________ Company Date
________________________________ ____________ Employee Date
________________________________ ____________ Witness Date
1. Congressional Research Service. The PREP Act and COVID-19: Limiting Liability for Medical Countermeasures. Updated
Mar. 19, 2021. hJps://crsreports.congress.gov/product/pdf/LSB/LSB10443.
2. Del Bigtree interviews 3 medical professionals incapacitated by Covid injections. The Highwire, Apr. 29, 2021.
hJps://www.bitchute.com/video/A4d8FB2cIBTc/.
3. America’s Frontline Doctors. Vaccines & the law. hJps://www.americasfrontlinedoctors.org/legal/vaccines-the-law.
4. Layton, Catharine. Forced to get the COVID vaccine? ICAN may be able to help. The Defender, Jan. 29, 2021.
hJps://childrenshealthdefense.org /defender/forced-to-get-covid-vaccine-ican-may-be-able-to-help/ .
5. hJps://uscfc.uscourts.gov/sites/default/,les/Vaccine%20AJorneys.pdf.
6. The Solari Report. Family Financial Disclosure Form for Covid-19 injections. Mar. 1, 2021.
hpps://pandemic.solari.com/family-
financial-disclosure-form-for-covid-19-injections |
[Aljazeera] Walmart Inc., the largest private employer in the U.S., is requiring its headquarters and regional staff to be vaccinated by Oct. 4, joining Google in instituting a policy that may set a standard for corporate America as the highly contagious delta variant continues to spread.