Family Financial Disclosure Form for Covid-19 Injections
Disclaimer: This form is provided to facilitate effective family due diligence, communication, and planning. It is essential that each person and each family take responsibility to identify and access the information they believe to be most relevant to their situation and decisions, and take responsibility to assess and manage their individual and collective risk as they believe best.
Table of Contents
What Are the Covid-19 Injections?
Adverse Event Reporting
Health Care Proxy
Examples of Adverse Events Reported Following Covid-19 Injections
Public Databases Compiling Reports of Adverse Events
The goal of this Family Financial Form is to ensure that an adverse event or death of one family member does not translate into long-lived or permanent financial destruction for the entire family.
This form was created to assist families to communicate regarding and to prepare for the family-wide financial impact of adverse events, if any, resulting from a Covid-19 injection. Examples of adverse events from Covid-19 injections include Covid-19 infection; anaphylaxis; neurological disorders; autoimmune disorders; other long-term chronic diseases; blindness and deafness; infertility, fetal damage, miscarriage, and stillbirth; and death (see Table 1 for examples of each).
Traditionally, informed consent forms for vaccination do not provide disclosure or statistics related to financial costs of possible injury, disability, or death, nor do they discuss the impact on family time, resources, health, and wealth— impacts that may include reduced career potential, divorce, and effects on siblings’ education and future plans.
Consequently, it is essential that prior to receiving a Covid-19 injection, parents and family members with financial responsibility for children and spouses not only perform thorough due diligence—providing adequate disclosures to their families regarding the potential costs to family members of adverse events or death—but also take steps to protect themselves and family members from the material adverse financial consequences of an adverse event or death.
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