As your employee, I am requesting that you review this document, provide the requisite information (item 14), and sign the form, in regards to your (proposed) requirement that I be inoculated with one of Big Pharma’s experimental Covid-19 vaccines.

NOTE TO INSTITUTIONS OF HIGHER EDUCATION AND THE US MILITARY: The statements below apply tostudents or members of the US Military who are also threatened with being vaccinated – against their will – with experimental vaccines that have not yet been tested for long-term safety or efficacy.

1) If I agree to receive an EUA (experimental) Covid-19 injection, does my employee health insurance plan provide
complete coverage should I experience an adverse even, or even death?

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?

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?

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 Covid-19 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 on 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

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.

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 option to accept or refuse the EUA product….” Are you aware of this statement?
Have you informed all employees that they have the option to refuse?

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
option 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/experimental 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?

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?

9) The United States Code of Federal Regulaons16 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?

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?

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?

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

13) Are you aware that employees could file a civil suit against you should they suffer an adverse
event, death, or termination from their place of employment?

14) As the legally authorized officer of the company, I have read all of the above information,
have provided my employees/students 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.


Important Information for Employers from America’s Frontline Doctors

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