Vaccine Toxic Exposure Survey

Kevin Thomson

May 12, 2022

Welcome to the Vaccine Toxic Exposure Survey

Having a DD-214 and Medical Record ready may help answer some questions but is not required

Press Next to get started

What is your Name?

What is your Gender

Man

Woman

Transgender

Non-Binary/Non-Conforming

Prefer not to Answer

None

What is your Age

Are you Currently Employed?

Yes No None

Are you receiving compensation through the VA for service connected disabilities?

Yes No None

What is your VA disability Rating?

Are you Collecting Social Security Disability Insurance (SSDI)?

Yes No None

At what age did you begin receiving SSDI?

What Branch(es) of Military Were you In

Army

Army Reserves

Army National Guard

Navy

Navy Reserves

Marine Corps

Marine Corps Reserves

Airforce

Airforce Reserves

Airforce National Guard

Coast Guard

Coast Guard Reserves

Civilian Contractor

What was your MOS or Rate (Navy)

Were you Medically Discharged?

Yes

None

Did you serve in the Continental U.S. Area?

This does NOT include Alaska or Hawaii

This DOES include any training or shore duty

Yes

None

What Time and Places did you serve in CONUS?

Example: NAS Oceana 97-05, FT. Hood 93-94, etc

Did you Deploy to Southwest Asia area

(Iraq, Kuwait, Saudi Arabia, Neutral Zone Between Iraq & Saudi Arabia, Bahrain, Qatar, United Arab Emirates, Oman, Gulf of Aden, Gulf of Oman, Waters of the Persian Gulf, the Arabian Sea, and the Red Sea, the Airspace above these locations)

Yes

None

Where in Southwest Asia Theater were you located and years?

Did you serve outside the Continental U.S. Area?

Other than Southwest Asia Theater of Military Operations

Yes

None

What Time and Places did you serve OCONUS?

Example: NAF Atsugi - Japan 93-97, NATO LANDCOM - Turkey-04-05, etc

Did you Receive the Anthrax Vaccine?

Yes No None

Which Vaccinations or Treatment Protocols are Recorded on your Medical Records?

Yellow Fever

Typhoid

Oral Typhoid

Cholera

Hepatitis A

Hepatitis B

Menigitis

Whooping Cough

Polio

Oral Polio

Tetanus

Japanese Encephalitis

Influenza

Influenza Intranasal

Measels, Mumps, and Rubella (MMR)

Meningococcal (MGC)

PPD

TB Skin Test

Anthrax

Botulinum Toxoid

Pyridostigmine Bromide Pills

Mefloquine (Malaria Drug)

Small Pox

Adeno Virus

I Don't Have My Record

Which Vaccinations or Treatment Protocols are NOT Recorded on your Medical Records?

Separate each one by a comma please.

Have you Received the Following Anthrax Lot Numbers?

FAV008 FAV017 FAV020 FAV030 FAV038 FAV041 FAV043 FAV047 FAV048b FAV066 FAV068 FAV069 FAV070 FAV071 FAV073 FAV074 FAV075 FAV078

What dates did you receive the Anthrax Vaccine?

If you didn't receive the entire series, leave those dates blank
MM/DD/YY, MM/DD/YY, etc.

How long after the Anthrax Series did you first notice symptoms?

Immediately

2-5 Months

6 Months

1 Year

2Years

3-4 Years

5-10 Years

10+ Years

None

Have you been exposed to any of the following: (Multiple Response)

Agent Orange or other herbicides

Chemicals (solvents, cleaners, degreaser, etc)

JP-4/5/8 Jet fuel (Direct skin exposure)

Sand/Dust Storms

Smoke from burning trash/feces

Smoke from Oil Fires/Wells

Depleted Uranium

None of the Above

In General, would you say your health is? (Select an Answer)

Excellent

Very Good

Good

Fair

Poor

None

Do you suffer from any of the following: Neurological Issues?

Forgetful or Trouble Remembering Things

Short Term Memory Loss

Cognitive Dysfunction

Dizziness

Migraines

Light Sensitivity

Loss of Balance

Disorder of Autonomic Nervous System

Insomnia

Sleep Disturbance

Sleep Apnea

Night Sweats

Tremors

Chemical Sensitivity Disorder

Passing out and fainting

None of the Above

Neurological Issues - Page 2

Paralysis

Feeling hot or cold regardless of weather

Numbness or tingling in any part of the body

Troubles with Sensory Processing (site, touch, taste, smell, or hearing)

Parkinson's Disease

Dementia or Alzheimer's disease

Peripheral Neuopathy

Lyme's Disease

Lou Gehrig's disease Also called: ALS, amyotrophic lateral sclerosis

Raynaud's Phenomenon

Restless Leg Syndrome

Other Neurological Issues

None of the Above

Do you suffer from any of the following: Psychological Issues?

Depression

Anxiety

PTSD

Thank You for taking the time to fill out the survey.

If you would like to schedule time for a one on one consultation and learn more about our projects, what you can do to help, or how to participate in our documentary. You may reserve time by visiting our board members page.

Please Press Submit to Finish

Time's up

Kevin Thomson

Kevin is a former Navy Aviation Machinist Mate, and Former Department of Defense Systems Engineer. Besides being very mechanically inclined, he holds a Bachelors of Computer Science. Kevin is a vaccine injury veteran and spends his spare time helping Operation Truth with their mission.

Welcome to the Vaccine Toxic Exposure Survey

Having a DD-214 and Medical Record ready may help answer some questions but is not required

Thank You for taking the time to fill out the survey.

If you would like to schedule time for a one on one consultation and learn more about our projects, what you can do to help, or how to participate in our documentary. You may reserve time by visiting our board members page. Please Press Submit to Finish

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If you would like to schedule time for a one on one consultation and learn more about our projects, what you can do to help, or how to participate in our documentary. You may reserve time by visiting our board members page.

Please Press Submit to Finish