For most of us, the giving of vaccines to children has been an acceptable practice for many years. Many of us received vaccines as children and suffered no harmful effects. Unfortunately, vaccines, for all the lives they have saved, are still drugs, capable of causing serious illness or injury and even death.

The decision not to immunize your child involves potentially putting your child at risk for contracting serious, possibly deadly, diseases. For the most part, vaccinating your child is clearly a better alternative to contracting the disease the vaccine is designed to prevent.

Thankfully, most people experience no reaction to vaccinations. But what happens when your child is unfortunately injured by a vaccine? Rarely, serious side effects do occur, such as:

• Allergic reactions
• Stroke
• Heart attack
• Encephalopathy
• Brain damage
• Seizure
• Coma

Vaccines known to cause side effects include:

• Tetanus Toxoid
• Diphtheria-Tetanus-Pertussis
• Measles-Mumps-Rubella
• Rubella
• Measles
• Polio
• Hepatitis B
• Hepatitis A
• Hemophilus influenzae type b
• Varicella (Chicken Pox)
• Rotavirus
• Pneumonia
• Trivalent ("Adult Flu")

For individuals suffering harmful side effects, the Vaccine Injury Compensation Program allows claims to be made for certain vaccine side effects.

The experienced South Jersey vaccines' attorneys at Anapol Schwartz Weiss Cohan Feldman & Smalley wholeheartedly support the current vaccination program and recommend that all scheduled vaccines be administered for the well-being of your children.

However, if your child suffers a vaccine-related reaction, seek immediate medical attention. Once the crisis is over, contact us to find out what steps to take next. Your child may have rights to compensation through the National Vaccine Injury Compensation Program (VICP).

Do I Qualify for the National Vaccine Compensation Program? PERSONAL INFORMATION
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INJURED PERSON INFORMATION
Date of Birth:	MM January February March April May June July August September October November December DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
For whom are you inquiring about?	PLEASE SELECT Minor Self Other
If you are NOT inquiring on your own behalf, what is your relationship?
Is the person deceased?	Yes   No
If deceased, the cause of death as stated on the death certificate:
Date of Death:	MM January February March April May June July August September October November December DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
Was there an autopsy performed?	Yes   No
INJURY INFORMATION
Has person had any of the following injuries within 48 hours of recieving the vaccination:
Encephalopathy Stroke Heart Attack Brain Injury Death Seizure Guillian-Barre Syndrome
DRUG INFORMATION
Has person had any of the following vaccinations:
Tetanus Pertussis Measles Mumps Chicken Pox (Varicella) MMR Rubella Polio Hepatitis B Rotavirus (Rotashield) Flu Shot DTaP DPT
Other:
Dates that Vaccine(s) were given?
Did behavior regress after receiving vaccines?	Yes   No
If yes, please describe regressive behavior:
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