Document Your Story Please fill out as much information as you can. While most fields are optional and the entire form does not to be completed in order to submit your story, the more information you are able to provide, the better we will be able to serve you and advance our mission. You can suggest a title for your story if you like. Name of Victim * Please use real names to help validate the story, but we can anonymize the victim's name prior to publishing if you prefer, just tell us during your interview. Tell us about the victim Let others know about this person in a few words. Example: "Loving parent of 3 young sons" or "lit up the room," or "touched the lives of all who knew them". Pictures of Victim Please share images from the victim's life that joyfully represent the person they were prior to this incident - you will have an opportunity to add photos of the abuse or injury later on. 0% Add Photos Close Update Age of Victim How old was the victim at the time of injury? Sex of Victim Please tell us the sex of the victim.MaleFemaleOther / rather not say Was the victim on Medicare or Medicaid? Was the victim receiving Medicare or Medicaid benefits?MedicareMedicaidMedicare and MedicaidVA HealthcareTri-CareOther government assistanceNoRather not say Did the victim have health insurance? Was the victim insured at the time of hospitalization or injury?YesNoI don't know or would rather not say Please choose the victim's health insurance provider If the victim had health insurance, please select your provider from this list. If the insurance provider is not listed, please scroll to the bottom of this list and select "Other" so you can input the insurer below.AARPAetnaAll Savers Insurance CompanyAlliant Health PlansAmbetter from Sunshine HealthAmerican Family InsuranceAnthem Blue Cross Blue ShieldAssurantBankers Fidelity Life Insurance CompanyBlue Cross Blue Shield AssociationBright HealthChristian Care MinistryCignaClover HealthCofinityCommunity Health ChoiceConnectiCareContinental Life Insurance Company of Brentwood, TennesseeCoreSourceEBMS (Employee Benefit Management Services)EMI HealthEquitableEvergreen HealthFallon HealthFirst Health NetworkFlorida BlueGeisinger Health PlanGolden Rule Insurance CompanyGroup Health CooperativeGuardian Life Insurance Company of AmericaHarvard Pilgrim Health CareHealth Alliance Medical PlansHealth NetHealthPartnersHealthfirstHealthMarketsHealthSmartHighmark Blue Cross Blue ShieldHMO LouisianaHumanaHumanaOneINTotal HealthIndependence Blue CrossKaiser PermanenteLasso HealthcareLiberty HealthShareLifeWise Health Plan of OregonMedicaMedical Mutual of OhioMedical Mutual of WashingtonMeritain HealthMolina HealthcareNational General Accident & HealthNationwideNew Era Life Insurance CompanyOptima HealthOptimumOscar HealthPalmetto GBAPhysicians Health Plan of Northern IndianaPiedmont Community Health PlanPOMCOPremera Blue CrossProvidence Health PlanQualChoiceRegence Blue Cross Blue ShieldSamaritan Health PlansSanford Health PlanSelectHealthSIHO Insurance ServicesSimply Healthcare PlansSoundpath HealthState FarmTricareTufts Health PlanUMR (United Medical Resources)UnicareUnion Security Insurance CompanyUnited HealthcareUniversal AmericanUSAAUS Health GroupUPMC 4 You / UPMC 4 LifeVantage Health PlanWellCareWPS Health InsuranceOther/Not listedI don't know or would rather not say Health Insurance Provider If the victim had health insurance but their provider is not listed, please tell us the victim's health insurance provider. Was the victim in the armed forces, or law enforcement? Was the victim in the armed forces or police force?Active-duty militaryVeteranVeteran and law enforcementActive-duty law enforcementRetired law enforcementOther active government agentOther retired government agentNoRather not say What branch of the armed forces did they serve? If the victim served in the armed forces, what branch did they serve?ArmyNavyAir ForceMarinesCoast GuardNational GuardNational ReservesSpace ForceRather not say Was the victim considered special needs, or did they have any kind of disability? If the victim was considered special needs or had any kind of disability, please check the box. Please describe the nature of the victim's disability or special needs. If the victim was considered special needs or had any kind of disability, please tell us what disability or special needs the victim had. Is the victim the subject being interviewed? Check the box if the victim is the subject being interviewed (if you are the victim), rather than a loved one. Person being interviewed The name of subject documenting this case and being interviewed - leave blank if subject is victim. Relationship To Victim Your relationship to the victim, or the relationship of subject to victim. Email * The email address of the person being interviewed or the primary contact for this case. This will not be displayed on the site, but will be used for verification purposes. Phone Number * The phone number of the person being interviewed or the primary contact for this case. This will not be displayed on the site, but will be used for verification purposes. Location In what state did the incident take place?Select A StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOutside The US Zip Code What was the zip code of the victim's residence during the time that this happened? Where outside the US? Where did the incident take place?Select A CountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Would you like to talk with or meet with other victims in your state? If you would like to talk with or meet with other victims and families of victims in your state, please check the box. What is this case about? * There are many different crimes against humanity taking place right now. Select all that are relevant to the experience you are documenting. Hospital Mistreatment Survived FDA Death Protocol including Remdesivir Murdered by FDA Death Protocol including Remdesivir Harmed by Mandates Murdered by Mandates Injured by COVID Vaccines Murdered by COVID Vaccines Which mandate was the victim impacted by? Which mandates played a factor in the victim's decisions that led to their harm or demise? Check all that apply. Vaccine Mandates - Social Pressure Vaccine Mandates at Work Vaccine Mandates at School Testing Mandates - Social Pressure Testing Mandates at Work Testing Mandates at School Movement License Mandates Mandate-Based Travel Restrictions Mandate-Based Forced Isolation Mask Mandates Has this incident been reported to VAERS? Has this incident been reported to the federal Vaccine Adverse Events Reporting System (VAERS)?Yes and they have respondedYes but they have not respondedNoNot Yet VAERS ID Number Has this incident been reported to the federal Vaccine Adverse Events Reporting System (VAERS)? VAERS Response Paste the content of the VAERS response below. Has this incident been reported to CICP? Has this incident been filed with the Countermeasures Injury Compensation Program (CICP)?Yes and they have respondedYes but they have not respondedNoNot Yet CICP ID Number Provide your Countermeasures Injury Compensation Program (CICP) ID Number. CICP Response Paste the content of the CICP response below. How did mandates impact the victim? Elaborate on how mandates played a role in what happened to the victim. Was the victim administered a COVID-19 'vaccine'? Please check the box if the victim received any so-called COVID vaccines.YesNoNot sure/Prefer not to disclose How many vaccines and boosters was the victim administered before onset of symptoms? How many "vaccines" and "boosters" were administered to the victim before adverse reactions developed?doses How many vaccines and boosters was the victim administered altogether? How many "vaccines" and "boosters" were administered to the victim, in total?doses Was the victim informed about the EUA status of COVID vaccines? Was the victim informed that COVID vaccines only have Emergency Use Authorization from the FDA, and are not actually 'FDA approved'?Yes, victim was informed about EUANoVictim or family does not recall Was the victim informed of potential vaccine side effects? Was the victim informed of potential COVID-19 vaccine side effects before being given the injection?Yes, victim was informed about side effectsNoVictim or family does not recall Was the victim asked to sign a waiver or consent form? Was the victim asked to sign a waiver or consent form in advance of being vaccinated?YesNoVictim or family does not recall Date victim was vaccinated Date of first COVID vaccination Brand of vaccine victim was vaccinated with for first vaccination If you know the brand of the first COVID vaccine the victim was administered, tell us here.Pfizer–BioNTechOxford–AstraZenecaSinopharm BIBPModernaJanssen (J&J)CoronaVacCovaxinNovavax Batch number for first vaccination If you know the batch number for the first COVID vaccine the victim was administered, tell us here. Date victim was vaccinated the second time Brand of vaccine victim was vaccinated with the second time What brand of COVID vaccine was the victim injected with the second time?Pfizer–BioNTechOxford–AstraZenecabibp: Sinopharm BIBPModernaJanssen (J&J)CoronaVacCovaxinNovavax Batch number for second vaccination If you know the batch number for the second vaccine the victim was administered, tell us here. Date victim was vaccinated the third time Brand of vaccine victim was vaccinated with the third time What brand of COVID vaccine was the victim injected with the third time?Pfizer–BioNTechOxford–AstraZenecaSinopharm BIBPModernaJanssen (J&J)CoronaVacCovaxinNovavax Batch number for third vaccination If you know the batch number for the third vaccine the victim was administered, tell us here. Date victim was vaccinated the fourth time Brand of vaccine victim was vaccinated with the fourth time What brand of COVID vaccine was the victim injected with the fourth time?Pfizer–BioNTechOxford–AstraZenecaSinopharm BIBPModernaJanssen (J&J)CoronaVacCovaxinNovavax Batch number for fourth vaccination If you know the batch number for the fourth vaccine the victim was administered, tell us here. Date victim was vaccinated the fifth time Brand of vaccine victim was vaccinated with the fifth time What brand of COVID vaccine was the victim injected with the fifth time?Pfizer–BioNTechOxford–AstraZenecaSinopharm BIBPModernaJanssen (J&J)CoronaVacCovaxinNovavax Batch number for fifth vaccination If you know the batch number for the fifth vaccine the victim was administered, tell us here. Date victim was vaccinated the sixth time Brand of vaccine victim was vaccinated with the sixth time What brand of COVID vaccine was the victim injected with the sixth time?Pfizer–BioNTechOxford–AstraZenecaSinopharm BIBPModernaJanssen (J&J)CoronaVacCovaxinNovavax Batch number for sixth vaccination If you know the batch number for the sixth vaccine the victim was administered, tell us here. Date victim was vaccinated the seventh time Brand of vaccine victim was vaccinated with the seventh time What brand of COVID vaccine was the victim injected with the seventh time?Pfizer–BioNTechOxford–AstraZenecaSinopharm BIBPModernaJanssen (J&J)CoronaVacCovaxinNovavax Batch number for seventh vaccination If you know the batch number for the seventh vaccine the victim was administered, tell us here. Date victim was vaccinated the eighth time Brand of vaccine victim was vaccinated with the eighth time What brand of COVID vaccine was the victim injected with the eighth time?Pfizer–BioNTechOxford–AstraZenecaSinopharm BIBPModernaJanssen (J&J)CoronaVacCovaxinNovavax Batch number for eighth vaccination If you know the batch number for the seventh vaccine the victim was administered, tell us here. Date of onset of symptoms When did the victim first begin experiencing symptoms? Describe symptoms observed Please describe all symptoms experienced by the victim. First attempt to seek medical attention When did the victim first seek medical attention? Doctor(s) Tell us about the doctor or doctors involved in this case. 1 Doctor's NameWhat was the doctor's name? Doctor's PerformanceOn a scale of 1-10 where 1 is the worst possible and 10 is the best, please rate this doctor's performance. TreatmentElaborate on how this doctor treated the victim, any notable exchanges, or anything else you think we might want to know about this doctor. Add Doctor Was the victim admitted to the hospital? Was the victim admitted to the hospital in relation to this case?YesNo Hospital Hospital(s) victim was admitted to during the course of this ordeal. Hospital Zip Code What is the zip code of the hospital where the victim was treated (or mistreated)? County The county that the hospital is located in. Date of admission to hospital When was the victim first admitted to the hospital? Was the victim allowed to see family or have a patient advocate? While in the hospital, was the victim allowed to see family or given access to a patient advocate?Yes, victim was allowed to see familyYes, victim was allowed an advocateYes, victim had access to bothNo, victim was isolated How many days was the victim isolated? How many days was the victim isolated before being allowed contact with family or advocate? At the hospital, was the victim asked if they had been vaccinated? Was the victim was asked if they had been vaccinated and/or boosted by doctors or hospital staff?YesNo Was the victim treated differently as a result of disclosing their vax status? Does the victim or family feel they were treated differently by hospital staff as a result of disclosing their vaccination status?YesNoUnsure Describe how the victim was treated differently after disclosing vax status. If you believe the victim was treated differently by doctors and/or hospital staff after disclosing their vax status, please describe the experience. Was the victim asked to sign a DNR? Was the victim or the victim's family was asked to sign a Do Not Resuscitate order?Yes, victim was asked to sign a DNRYes, victim was pressured to sign a DNRYes, victim was relentlessly pressured or tricked into a DNRA DNR was ordered without consentVictim or family does not recall / not applicableNo Was the victim restrained? YesNoI don't know Was the victim deprived of food and water? Was the victim deprived of food and water while in the hospital?Yes, from the moment they were admittedYes, some time after they were admittedVictim or family does not recall / not applicableNo How long was the victim deprived of food and water? How many days was the victim deprived of food and water while in the hospital? What medications were administered to the victim in the hospital? What medications were administered to the victim by doctors or hospital staff? Please check all you believe were administered. Remdesivir Ativan/Lorazepam Antibiotics Antifungals Adrenaline Azithromycin Amlodipine Actemra Amlodipine Anxiety meds Atorvastatin Baricitinib Benzonatate Blood Thinners Blood Pressure Medications Budesonide Ceftriaxone Convalescent Plasma Clonidine Dexamethasone Dexametomidine Doxazosin Doxycycline Decadron Dilaudid Diuretics Enoxaparin Enoxaparin Epoetin Erythromycin Famotidine Fentanyl Formoterol Gabapentin Haldor Heparin Insulin Labetalol Lasix Lovenox Monoclonal antibodies Morphine Midazolam Nimbex Olumiant Oxygen Pain killers Pantoprazole Paralytics Polycarbofil Polyethyleneglycol Precedex Propofol Rocephin Sedatives Seroquel Sodium Chloride Steroids Tocilizumab Vancomycin Vassopressin Vitamin C Xanax Add new choice What medications were refused by the hospital? What medications did the hospital explicitly refuse to administer to the victim? Please check all you believe were administered. Ativan/Lorazepam Antibiotics Antifungals Adrenaline Azithromycin Amlodipine Actemra Amlodipine Anxiety meds Atorvastatin Baricitinib Benzonatate Blood Thinners Blood Pressure Medications Budesonide Ceftriaxone Convalescent Plasma Clonidine Dexamethasone Dexametomidine Doxazosin Doxycycline Decadron Dilaudid Diuretics Enoxaparin Enoxaparin Epoetin Erythromycin Famotidine Fentanyl Formoterol Gabapentin Haldor Heparin Hydroxychloroquine Insulin Ivermectin Labetalol Lasix Lovenox Monoclonal antibodies Morphine Midazolam Nimbex Olumiant Oxygen Pain killers Pantoprazole Paralytics Polycarbofil Polyethyleneglycol Precedex Propofol Remdesivir Rocephin Sedatives Seroquel Sodium Chloride Steroids Tocilizumab Vancomycin Vassopressin Vitamin C Vitamin D Xanax Zinc Add new choice Was the victim informed about remdesivir's EUA status? Was the victim informed that remdesivir has only Emergency Use Authorization from the FDA, and is not actually approved to treat COVID?Yes, victim was informed about EUANoVictim or family does not recall Was the victim informed of potential remdesivir side effects? Was the victim informed of potential remdesivir side effects before being given the drug?Yes, victim was informed about side effectsNoVictim or family does not recall Was there consent for the use of remdesivir? Did the victim or the family consent to the use of remdesivir?Yes, victim gave consentYes, family gave consentNoVictim or family does not recallCoerced or consented under duress How long was the victim on remdesivir? How many days was the victim being administered remdesivir? Was the victim placed on a ventilator? Was victim was placed on a ventilator?YesNo How many days was the victim on the ventilator? Date victim was placed on a ventilator When was the victim first put on a ventilator? Was the victim given a diagnosis by a medical professional? Has any medical professional given a diagnosis indicating what the victim is suffering from?YesNoVictim or family does not recall What was the diagnosis? What was the victim diagnosed with? Check all that apply, or input your own selections. ALS Alzheimer's Anaphylaxis Anemia Anxiety Arrhythmia Asthma Autoimmune disease Bell's palsy Cancer Blood Clots COVID Pneumonia Cardiopulmonary syndrome Dysautonomia Fibromyalgia Guillain–Barré syndrome Hashimoto encephalopathy Heart Disorder HIV Hypertension Immune thrombocytopenia Left bundle branch block Leaky heart valves Leukemia Lupus Lymphoma Multiple sclerosis Myocarditis Parkinson's Pericarditis Pericardium rupture Postural Orthostatic Tachycardia Syndrome Prion disease Protein C deficiency Shingles Sudden-onset deafness Sudden-onset ALS Supraventricular tachycardia Thyroiditis Tinnitus Vaccine Induced Thrombotic Thrombocytopenia Add new choice How was the victim treated while at the hospital? Generally, how was the victim treated while at the hospital?- Select -Received excellent careTreated wellTreated adequatelyTreated poorlyCruelly mistreated How was the victim mistreated? Check all that apply. If you add an item that is not listed, keep it short: a few words or less. Refused treatment Isolated Neglected Deprived of food Deprived of water Gaslighted Derided Openly mocked Euthanized Add new choice Elaborate on the victim's experience in the hospital A brief summary of how the victim was treated in the hospital Photos that document the abuse or injury Images that document hospital abuse, mistreatment, or neglect, or pictures that highlight 'vaccine' injuries can be uploaded here. 1 Photographic evidence 0% No image selected Add Photo Can we share this publicly?If you would like to allow us to share these images publicly, please check the box. If you would like us to keep these on file for reference, leave the box unchecked. This photo may be displayed publicly About this imageYou can tell us a few words about what is happening in this image if you like. Add Photographic Documentation Victim Survival Did the victim survive? Check the box if they lived to tell their story. Uncheck the box if they died as a result of what happened. Date Of Death What was the official cause of death? If there was a cause of death determined by officials, please check all that apply. COVID-19 Stroke Heart Attack Blood Clots COVID Pneumonia Vaccine Injury Organ Failure Natural Causes Septic Shock Add new choice What does the family believe was the cause of death? What do you think killed the victim, or what does the family believe really killed their loved one? Remdesivir Ventilation Mistreatment Refusal To Treat Vaccine Injury COVID-19 Stroke Blood Clots Euthanized Renal Failure Septic Shock Add new choice Was victim or family able to obtain a complete set of medical records? Medical records can help piece together what happened to the victim. Have you obtained, or do you plan to obtain a complete set of medical records?- Select -Yes, a complete set of medical records was obtainedPartial records have been obtained and need help getting the restNo, but trying to obtain medical recordsNo, and need help obtaining medical recordsNo, and don't plan to obtain medical records Are there discrepancies in the medical records? Have discrepancies been identified in the medical records?Yes, there are many discrepanciesYes, there are some discrepanciesYes, there are a few discrepanciesThere may be discrepancies, not sureNo discrepancies have been identified Is the victim or the family pursuing legal action? Is the victim or the family pursuing legal action against the doctor or hospital?YesNot at this timeNo, but would like to Has the victim or the family obtained legal representation? Has the victim or family already retained a lawyer or legal team to help with this case?YesNot at this timeNo, but would like to Legal Representation If the victim or family is pursuing legal action and has retained legal representation, who is representing them? Is the victim or the family engaging in activism as a result of this experience? Is the victim or the family engaging in any activism as a result of this experience?YesNot at this time What kind of activism is the victim or family engaging in? What victim or family doing to ensure this doesn't happen to anyone else? What is their advice for other families going through this experience? What do they believe should be done to bring justice to their loved one? Website or social media page associated with this story If there is a website or social media page associated with this story that you would like to include in your case, you can link to it here. Is there anything else you think we should know? Is there anything else you think the world should know about what happened? Would you like to join our support group? We hold a support group for victims of the FDA Death Protocol and their families, every Monday evening. The group would love it if you would join us and share your story with others who have been through this.Yes, I would love toYes, I have already been attendingMaybe, I would like to know moreNot at this time Would you like to join the FFFF Citizens Task Force? We have a task force seeking justice for victims of the FDA Death Protocol and their families, and pursuing action other issues essential to our liberty. Would you like to join The FFFF Task Force?Yes, I would love toMaybe, I would like to know moreNot at this time Would you be interesting in participating in a series of podcasts? Task Force members are organizing a series of podcasts highlighting these crimes against humanity and the assault on medical freedom. Would you be interested in participating in these podcasts?Yes, I would love toMaybe, I would like to know moreNot at this time Referred by: How did you find this site?FormerFedsGroupGoogleDuckDuckGoOther Search EngineFacebookTwitterOther Social MediaTask Force MemberOther Referred by TFM Who referred you? Please tell us the Task Force member's name, handle, or email address, if you know it. How did you find us? Please tell us how you found out about this site. Please tell us what happened We know it's difficult to go over it all again, but telling your story in your own words is the most powerful way to convey it. Please take your time and tell us as much or as little as you are comfortable with. If you absolutely cannot bring yourself to write it out, one of our volunteers may summarize your story based on the information you have provided and based on your interview. We prefer you tell your story, in as much detail as possible. Do you consent to allowing CHBMP, our partners, and any interested parties to publish and share this information? * By checking this box you agree to allow this site to publish the data on this form except where specified otherwise, to share the data with our partners, and to use this information in various ways as we pursue justice for all victims of these crimes against humanity. Submit This Case
