The form contains a questionnaire asking "vaccine" recipients to indicate if they feel sick, have received a previous injection for the Chinese Virus, are allergic to polyethylene glycol (PEG), and if they have ever tested positive for the Wuhan Flu.
"Do you have a weakened immune system caused by something such as HIV infection or cancer or do you take immunosuppressive drugs or therapies?" another of the questions asks.
The list reads like something one might fill out at a doctor's office before going in for an appointment. However, upon closer examination, its purpose is to basically have the signer sign away his or her life in the event that the jab causes life-threatening illness or death.
An immunocompromised person with allergies, for example, might still be told to get the injection but to wait around for 30 minutes afterwards rather than the usual 15 minutes. Should anything horrific occur after this time, the entity that administered the shot will be off the hook for any adverse events that may arise.
"Responses to these questions are not (on their own) contraindications or precautions to vaccination," the questionnaire emphasizes. "However, healthcare professionals should be prepared to discuss information and options with patients based on their responses to the following questions."
At the very bottom of the questionnaire is a list of the types of side effects jab recipients could experience. These include skin reactions such as pruritus, urticaria, flushing, and angioedema, as well as neurological dysfunction such as confusion, disorientation, dizziness, lightheadedness, weakness and loss of consciousness.
Some recipients may feel shortness of breath, wheezing, bronchospasms, stridor, or hypoxia, while others might experience hypotension, tachycardia, nausea, vomiting, abdominal cramps or diarrhea.
One of the strangest symptoms is "feeling of impending doom," which the questionnaire warns could arise within 15 to 30 minutes post-injection. Other possible side effects include unusual body temperature, clamminess, difficulty breathing, tunnel vision and hearing problems.
"In patients who experience postvaccination symptoms, determining the etiology (including allergic reaction, vasovagal reaction, or vaccine side effects) is important to determine whether a person can receive additional doses of the vaccine (including the 2nddose of an mRNA COVID-19 vaccine)" the document explains in the fine print.
"Providers should use their clinical judgement [sic] when assessing patients to determine the diagnosis and appropriate management."
If this does not make you want to hop off the fence and line right up for your injection, we do not know what will. That was sarcasm, of course. Were people being told the full truth about what could happen to them after the syringe leaves their arm, chances are that far fewer people would willingly be getting needled.
The problem is that informed consent was killed by the Chinese Virus and replaced with medical fascism. Corporations and their government partners are now using every coercion tactic in the book to try to persuade the "hesitant" to get injected based on the promise that everything will go back to "normal" if they do.
Holding people hostage like this under duress of getting an experimental (gene therapy) vaccine is what authoritarian regimes do, not what governments by the people and for the people do. Clearly the Biden regime is not a government by the people and for the people.
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Sources for this article include: