NSH VACCINES

Consent checklist
For Covid-19 Vaccination

If you choose to have a vaccine for yourself or your child, you should thake this form to your appointment and ensure it is signed by booth you and the clinician.
"Informed consent" means agreeing to something once you have been given the full information surruning it. Informed consent is legally reuired in the UK before you undergo a medical procedure, such as Covid-19 vaccinations.

Both patient/carer and clinican should tick the box for each statement they understand. See overleaf for verifications.

Statement (Patient/Clinician)

1. Unline traditional vaccines, the vaccines being used for Covid-19 (*the Covid-19 vaccines") instruct the body cells to create the Sarc-Cov-2 spike protein.

2. The Covid-19 vaccines may reduce severiry of symptoms if the patient gets Covid-19, but may not prevent them from getting Covid-19 nor from passing it on.

3. Although alternative treatments are available, the Covid-19 vaccines have been granted Emergency Use Authorisation, so require less comprehensive clinical data.

4. By 8 Sep 2021, of the 48,344,566 people that had received at least one jab, there had been 1,646 deaths (1 in 29,389 chance of dying from vaccine) and 1,196,813 adverse reaction officially reported. The actual figures may be ten times higher. Adverse reactions were reported more oftne in younger people than older adults.

5. Adverse reactions to the Covid-19 vaccines include, but are not limited to: strokes, blindess, deafness, clotting, miscarriages, anaphylaxis and cardiovasculat disorders.

6. We will not know what the possible long term effect of the Covid-19 vaccines may be (e.g., infertility) until after the studies of the clinical trials conclude in 2023. For this reason, the Covid-19 vaccines may be considered experimental.

7. The maunfactures of the Covid-19 vaccines are immune from civil liability.

8. As of 11 Jan 2021, the average age of death in the UK with Covid-19 was 83.

9. Crude mortality rates from 29 Jun 2021 to 12 may 2021 show under-30's may be more likely to die from taking a Covid-19 vaccine that from dying with Covid-19:

- Under fives 1 in 500,0000 chance of dying with Covid-19
- 5 to 9 years-old: 1 in 1,000,000 chance dying with Covid-19
- 10 to 19 years-old: 1 in 166,667 chance dying with Covid-19
- 20 to 29 years-old: 1 in 43,478 chance dying with Covid-19
- 30 to 39 years-old: 1 in 12,500 chance dying with Covid-19
- 40 to 49 years-old: 1 in 4,065 chance dying with Covid-19
- 50 to 59 years-old: 1 in 1,399 chance dying with Covid-19
- 60 to 69 years-old: 1 in 500 chance dying with Covid-19
- 70 to 79 years-old: 1 in 189 chance dying with Covid-19
- 80 years-old and above: 1 in 44 chance dying with Covid-19

10. The patien/carer does not feel coerced and is free to refuse a chance dying with Covid-19 vaccine.

Signatures of the parties