Please
List all important health aspects including medications, vaccinations and other pertinent information. Please use this form
as a guideline to provide necessary information.
Before
pregnancy mother and father
ž Tropical vaccinations: typhoid, yellow fever, cholera, hepatitis A, hepatitis
B, rabies, DTP
ž Prevention of malaria (Malerone, Lariam)
ž Diseases with a chronic disturbance: Mononucleosis, Lyme, colitis, asthma,
epilepsy, depression, migraine, etc. and their treatment
ž Medication
ž Sleeping medication
ž Anti-depressives
ž Anesthetics
ž Dental fillings with amalgam (mercury)
ž Tetanus vaccine in case of wounds (tetanus toxoid)
ž Hepatitis B vaccine for physicians, nurses, lab analysts, etc.
ž IVF(invitrofertilization):Clomid(Clomifeen),Pregnil(Choriongonadotrofin
ž Injection between 28-30 weeks with AntiRhesus (D)-globulin(rhedQuin, Rhogam
or Rhophylac)
ž Use of pomades with hydrocortisone
ž Tobacco smoking or use of drugs: weed, cocaine, ecstasy
ž Operations
ž Influenza-vaccination
During pregnancy
ž IVF, Artificial insemination: Clomid, Pregnil
ž Dental treatment, especially with amalgam fillings
ž Vaccines, tetanus or tropical vaccinations
ž Medication in chronic diseases as asthma, colitis, epilepsy or other diseases
ž Medication against nausea and vomiting, high blood pressure or other
ž Mantoux (to control if a person has been infected with tuberculosis)
ž Medication for hypertension
ž Medication for sexually transmitted diseases
ž Use of hydrocortisone
ž Anti-acids: Maalox (aluminiumoxide)
ž Rennies (with 10 mg aspartame/tablet)
ž Antibiotics
ž Nose spray: with xylomethazolin,
ž Vaginal tablets against fungi like Candida: Canesten (dotrimazol), …
ž Sleeping medication
ž Inhibitors of contractions of the uterus (prepar, nifedipine)
ž Injections for maturation of the lungs in case of threatening early delivery:
betametason
ž Strong emotional events eventually with medication
ž use of deodorant(aluminium)
ž use of aluminum cooking pots
ž Antihistaminica
ž use of soft plastics
ž Tobacco smoking
ž Abuse of alcohol
ž Abuse of coffee
ž Abuse of drugs like hash, cocaine, weed, etc
ž Artificial sweeteners: aspartame; chewing gum with aspartame
ž Diet sodas with aspartame
ž Paracetamol 500, containing also 40mg aspartame
During delivery
ž Stimulator of contractions of
the uterus (oxytocin)
ž Medication for pain
ž Anesthesia
ž Sedatives
ž Sleeping medication
ž
Epidural:(containing
betamethason, oxytocin, ropivacaine, sufenta[opioid])
First 2 years of life
ž
Vaccinations:
BCG, Hepatitis B,DTPP/HIB/Pneumococcal, MMR, Meningococcal-C, varicella, DTPol, tropical vaccinations
ž Nose spray (Xylomethazoline)
ž Antibiotics
ž Anesthetics (e.g. for tubes in the ear drums)
ž Medication of the mother during breast feeding
ž Medication against reflux
ž Examinations with contrast fluids
ž Inhalors for COPD (asthma)
ž Pain medication: paracetamol
ž Antitussives (to suppress cough): promethazin
ž Warming up of the (plastic) bottle in the microwave;
plastic dummies; vinyl in the sleeping room; soft plastics making contact food
ž Anti-diarrhea medication:Loperamide
ž Antacids with aluminum
ž Eye drops: Sulphite nitrate
