HAVE YOU SUFFERED FROM A STILLBIRTH OR MISCARRIAGE DUE TO A COVID VACCINATION?

I AM SORRY FOR YOUR LOSS AND WOULD LIKE YOU TO KNOW THAT YOU ARE NOT ALONE OR FORGOTTEN.

Many Expecting Mothers Are Suffering From Miscarriages And Stillbirths Right After They Have Received A Covid-19 Vaccination.

Unfortunately, these grieving parents are being ignored with doctors refusing to acknowledge that it is a suspected adverse reaction, and in some cases, even without viewing an autopsy report!

There is no doubt that children and adults have had serious adverse reactions to Covid-19 Vaccinations, but what is also being covered up, is the amount of stillbirths and miscarriages that have occurred.

My heart goes out to each mother and father who has lost a baby as a result of a Covid-19 Vaccination reaction.

While I cannot bring a child back, what I will do is to keep exposing the incompetence of our governments and Health Departments and their refusal to acknowledge that there is a serious problem surrounding safety.

I will keep working to stop vaccine mandates and for ample compensation for those who have been injured or had family members die.

I would also like to connect with those who have lost a baby to offer any guidance during this difficult time.

IF YOU HAVE HAD A STILLBIRTH OR MISCARRIAGE AS A RESULT OF A COVID-19 VACCINATION, I WOULD LIKE TO HEAR FROM YOU.

Please contact me using the form below. Your details will be treated with sensitivity and confidentiality.

If you work in the medical industry please use the Medical Whistleblower Form.

COVID Vax Miscarriages & Stillbirths

Which have you experienced?

Miscarriage (up to 20 weeks gestation)

A stillbirth (20+ weeks gestation)

First Name (person filling out this form)

Last Name (person filling out this form)

Phone

Residential Suburb

State

Postcode

Your Occupation

Your age (at time of loss)

Your baby's gestational age (#weeks, #days)

Date that you lost your baby

Sex of your baby

Male

Female

Unknown

Did your GP/Hospital acknowledge or confirm that your miscarriage/stillbirth could be due to the Covid Vaccine?

Yes, they confirmed that it was a vaccine reaction (either verbally or in writing)

I said I thought it was a vaccine reaction and they said that it may be linked

I said I thought it was a vaccine reaction and they said that there wasn't enough information to say whether it was a contributing factor

I said I thought it was a vaccine reaction and was dismissed

They said they did not know the cause of the miscarriage or stillbirth

They said there wasn't enough information about the vaccine to say if it was a contributing factor

They said they did not know the cause and that there wasn't enough information about the vaccine to say if it was a contributing factor

They said it was not a vaccine reaction

My doctor/hospital did not say anything about a potential cause or the vaccine

Note: You may select multiple. You can provide more information about this in the "More Information" section at the end of this form.

FIRST VACCINATION INFORMATION

Which COVID Vaccine was administered for the FIRST vaccine? (click to choose)

Date of FIRST vaccine

FIRST Vaccine Batch Number (if known)

Did you experience any of these adverse reactions after FIRST Vaccine (you may select multiple)?

Blood Clots/Elevated D-Dimer Test Results

Myocarditis/Pericarditis/Chest Pain

Heart attack/Cardiovascular Damage

Stroke/Simulated Stroke

Paralysis/Numbness in limbs, face and other body parts

Severe headaches/Migraines

Neurological issues/Convulsions

Cognitive/sight disorders

Skin disorders/Hives/Severe Rash

Bleeding

Organ dysfunction

Blood disorders/diabetes/Bruising in area other than injection site

Anaphylaxis

Other Pain

Other (please describe below)

I did not experience an above adverse reaction after my first vaccine

Other reaction FIRST vaccine

Were you warned about possible adverse reactions by the person administering the FIRST vaccine or their colleague?

Yes, all of them

Some of the reactions

No, I was not told about any of the above reactions

Where did you have the FIRST vaccine?

GP/Doctor

Pharmacy

Pop-Up Vaccine Clinic/Centre

Other Health Service

Hospital

Place of Employment

Other

SECOND VACCINATION INFORMATION

Which COVID Vaccine was administered for the SECOND vaccine? (click to choose)

Date of SECOND vaccine

SECOND Vaccine Batch Number (if known)

Did you experience any of these adverse reactions after SECOND Vaccine (you may select multiple)?

Blood Clots/Elevated D-Dimer Test Results

Myocarditis/Pericarditis/Chest Pain

Heart attack/Cardiovascular Damage

Stroke/Simulated Stroke

Paralysis/Numbness in limbs, face and other body parts

Severe headaches/Migraines

Neurological issues/Convulsions

Cognitive/sight disorders

Skin disorders/Hives/Severe Rash

Bleeding

Organ dysfunction

Blood disorders/diabetes/Bruising in area other than injection site

Anaphylaxis

Other Pain

Other (please describe below)

I did not experience an above adverse reaction after my second vaccine

Other reaction SECOND vaccine

Were you warned about possible adverse reactions by the person administering the SECOND vaccine or their colleague?

Yes, all of them

Some of the reactions

No, I was not told about any of the above reactions

Where did you have the SECOND vaccine?

GP/Doctor

Pharmacy

Pop-Up Vaccine Clinic/Centre

Other Health Service

Hospital

Place of Employment

Other

THIRD VACCINATION INFORMATION

Which COVID Vaccine was administered for the THIRD vaccine? (click to choose)

Date of THIRD vaccine

THIRD Vaccine Batch Number (if known)

Did you experience any of these adverse reactions after THIRD Vaccine (you may select multiple)?

Blood Clots/Elevated D-Dimer Test Results

Myocarditis/Pericarditis/Chest Pain

Heart attack/Cardiovascular Damage

Stroke/Simulated Stroke

Paralysis/Numbness in limbs, face and other body parts

Severe headaches/Migraines

Neurological issues/Convulsions

Cognitive/sight disorders

Skin disorders/Hives/Severe Rash

Bleeding

Organ dysfunction

Blood disorders/diabetes/Bruising in area other than injection site

Anaphylaxis

Other Pain

Other (please describe below)

I did not experience an above adverse reaction after my third vaccine

Other reaction THIRD vaccine

Were you warned about possible adverse reactions by the person administering the THIRD vaccine or their colleague?

Yes, all of them

Some of the reactions

No, I was not told about any of the above reactions

Where did you have the THIRD vaccine?

GP/Doctor

Pharmacy

Pop-Up Vaccine Clinic/Centre

Other Health Service

Hospital

Place of Employment

Other

What was your reason for getting the vaccine? (you may select multiple)

I volunteered on my own to get the vaccine and was happy to get it

I volunteered on my own to get the vaccine but had some concerns about its safety

I felt pressured by my employer to get the vaccine and didn't really want to get it

I was told that I would lose my job if I did not get the vaccine and felt like I had no choice but to get it

I didn't want to get it but felt pressured by family/friends/community members/media/politicians

I didn't want to get it but was fearful of being refused entry to shopping centres, businesses, entertainment venues, sporting events and restaurants etc

I needed to visit loved ones in Aged Care

My medical carer/doctor told me I had to get it/they heavily promoted it to me

Other reason (please describe below)

Other reason

OTHER INFORMATION

Has your miscarriage/stillbirth been recorded with the TGA (Therapeutic Goods Administration)?

I'm not sure

My doctor/medical provider has recorded it with the TGA

I/another person has recorded it with the TGA

No, nobody has reported it officially with the TGA

I did not want my adverse reaction recorded with the TGA

Have you received the autopsy report back from the Coroner?

Yes

An autopsy was not performed/Not applicable

Did the autopsy mention the miscarriage/stillbirth as potentially being caused by a Covid Vaccine

Yes

What was the ultimate cause/causes of the stillbirth listed in the autopsy?

Upon receiving the autopsy report, did the State Coroner place a 'Non-Publication or Disclosure' condition on the report?

Yes

I'm not sure

What is the name of the Coroner?

What is the name of the Forensic Pathologist who performed the autopsy?

Please provide any other information here (more information section)

You may upload supporting evidence/documentation/images here

Choose File

Would you like me to share your story (e.g. social media channels) to help raise awareness about vaccine related miscarriages and stillbirths?

Yes

I'm not sure (maybe in the future)

If you select YES you consent to Senator Gerard Rennick publishing your story on his social media channels. Please also upload a picture of an ultrasound or other memory of your baby. If you would like us to blur any images, please indicate this in the 'More Information' section above.

Would you like me to share this report with other government departments or in Senate inquiries?

Yes

Yes, but please redact my name

I'm not sure (maybe in the future)

If you select YES you consent to Senator Gerard Rennick publishing this report with government departments or Parliamentary Inquiries. This report will only be published if consent is given by the person injured or their next of kin (if deceased).

I consent to Senator Gerard Rennick contacting me in the future. I understand I can opt-out of email communications at any time.

YES

HAVE YOU SUFFERED FROM A STILLBIRTH OR MISCARRIAGE DUE TO A COVID VACCINATION?

I AM SORRY FOR YOUR LOSS AND WOULD LIKE YOU TO KNOW THAT YOU ARE NOT ALONE OR FORGOTTEN.

Many Expecting Mothers Are Suffering From Miscarriages And Stillbirths Right After They Have Received A Covid-19 Vaccination.

Unfortunately, these grieving parents are being ignored with doctors refusing to acknowledge that it is a suspected adverse reaction, and in some cases, even without viewing an autopsy report!

IF YOU HAVE HAD A STILLBIRTH OR MISCARRIAGE AS A RESULT OF A COVID-19 VACCINATION, I WOULD LIKE TO HEAR FROM YOU.

Please contact me using the form below. Your details will be treated with sensitivity and confidentiality.

FIRST VACCINATION INFORMATION

SECOND VACCINATION INFORMATION

THIRD VACCINATION INFORMATION

OTHER INFORMATION

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