42% Of All Drug Reactions Are Vaccine Related

Adverse Drug Reactions of Spontaneous Reports in Shanghai Pediatric Population

Hui Li,^#1 Xiao-Jing Guo,^#1 Xiao-Fei Ye,^#1 Hong Jiang,^#1,2 Wen-Min Du,³ Jin-Fang Xu,¹ Xin-Ji Zhang,¹ and Jia He^1,*

Malcolm Gracie Semple, Editor

Author information ► Article notes ► Copyright and License information ►

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Abstract

Background

Knowledge of drug safety in the pediatric population of China is limited. This study was designed to evaluate ADRs in children reported to the spontaneous reporting system (SRS) of Shanghai in 2009.

Methodology and Principal Findings

Crude ADR reports submitted to Shanghai SRS in 2009 for individuals aged from birth to 17 years (including 17 years) were included. Data were analyzed with respect to age, gender, category of ADR (System Organ Class [SOC]), the severity of reports and type of reporter.

Results

A male overrepresentation was observed regarding the total number of reports. The most frequently reported group of drugs were vaccines (42.15%). Skin rash and fever were the commonest symptoms reported in the total pediatric dataset. The proportion of children that suffered from a serious ADR was 2.16% and that for drug related deaths was 0.34%. And we found that the multiple drug exposure experienced a high proportion of serious ADRs compared with the single drug use (χ²=15.99, P<0.0001). Sixty-five percent of ADRs were for children less than 6 years of age. And more than half of reports were from doctors.

Conclusions

In our study, consumers were more likely to report new ADRs though they appear to contribute a relatively small percentage of total reports. We propose that patients would take an active role in reporting ADRs. More researches are needed in order to achieve better understanding the characteristics of ADRs in pediatric population of China.

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Introduction

Adverse drug reaction (ADRs) are defined as events related to a medication that are noxious, unintended and occur at normal doses used in humans for prophylaxis, diagnosis or therapy of disease, or for modification of physiological function by World Health Organization (WHO). This definition excludes accidental or deliberate excessive dosage or maladministration [1]. ADRs are one of the leading causes of morbidity and mortality in many countries [2], [3]. In the UK a major study of hospital patients found that up to 6.5% of admissions were due to ADRs, and 2.3% of those patients died after admission in hospital [3]. A systematic review have shown that the incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children (pooled estimate of 2.9% (2.6%, 3.1%)) and from 0.6% to 16.8% of all children exposed to a drug during hospital stay [4]. In addition, ADRs constitute a major cost factor in public health care. Almost 5% of hospital admissions in the pediatric setting and 10% of hospitalized pediatric patients are presumably due to drug related problems [5], [6], [7]. A large variety of drugs are used in children now [8], although many of them have been marketed without trials regarding the efficacy and safety in this population. Little attention has been paid to the safety of medicines in children [9], [10]. The ADRs resulting from the administration of a drug that has not been test and proven in the pediatric population through proper clinical trials may therefore lead to significant morbidity and death among children [11], [12]. In a meta-analysis of 17 prospective studies performed in the United States and Europe, the overall incidence of ADRs in hospitalized children was estimated to be 9.53% (95% CI 6.8 to 12.6) and in pediatric outpatients 1.46% (95% CI 0.7 to 3.3), and serious reactions accounted for 12% of the total number of ADRs. The contribution of ADRs to the hospitalization of children was estimated to be 2.09% (95% CI 1.02 to 3.77) [7]. Knowledge of drug safety is limited in the pediatric population, especially for off-label drugs. Less than half of those specifically intended for children are operated on the basis of clinical trials which demonstrate specific features of risk-benefit balance in children [13]. Spontaneous reporting of ADRs has been shown to be an important method of increasing such knowledge and the method could be considered particularly important in children since drugs are not routinely test in the pediatric population [14]. A major function of the spontaneous reporting system is early detection of signals of new, rare or serious ADRs. The SRS covers a large number of patients and a wide range of drugs. It is therefore a relatively cost-effective method for drug safety monitoring [15]. However, few studies were conducted to investigate knowledge of drug safety in Chinese children.

The Shanghai ADR SRS is a part of China ADR SRS and one of the major goals of this system is the timely detection of possible new ADRs. There are 12000–16000 ADR reports submitted to the system annually now. Both urban and rural areas in Shanghai are included in this ADR monitoring scheme, covering more than 17,000,000 inhabitants. Pharmaceutical manufactures, healthcare professionals (HCPs), and drug dealers are the main sources of reports. This scheme is a voluntary reporting system without any incentive. The monitoring scheme includes not only prescribed medications, but also over the counter, traditional Chinese remedies, etc. In this study, we demonstrated the characteristics of suspected pediatric ADRs reported to the Adverse Drug Reaction Monitoring Center of Shanghai.

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Methods

Data Acquisition

The data was downloaded automatically from the system via http://www.adr.gov.cn, which was developed by National Adverse Drug Reaction Monitoring Center of China. We cannot get ADR incidence rates as the true extent of drug use was unknown, so all the data in the manuscript were frequency of reports. Personal information was excluded in our dataset, and individual identify codes in SRS were marked with random numbers. The study was approved by the Ethics Committee of the Second Military Medical University, Shanghai, China. The ethics committee waived the need of informed consent for the study because of its retrospective nature and data were analyzed anonymously.

Data Coding

The ADR names were coded according to MedDRA (Medical Dictionary for Regulatory Activities, version 3.0.2b) terminology at SOC level. In addition, generic names of drugs were standardized and coded according to the catalogue of generic names for common prescription drugs issued by the Ministry of Health of China in 2007. The website http://app1.sfda.gov.cn/datasearch/face3/dir.html and Chinese Pharmacopoeia were also used as materials for our work [16]. We classified each ADR as a general, serious, new general or new serious reaction based on the Measures for the Reporting and Monitoring of Adverse Drug Reactions definitions [17]. Serious Adverse Drug Reactions means one of the following harmful situations caused by taking drugs: 1. Results in death; 2. Results in cancer, a persistent of significant disability/incapacity; 3. Results in life threatening; 4. A persistent of injury to organ function; 5. Results in hospitalization or prolongs an existing inpatient hospitalization. And new ADRs means adverse reactions that are not recorded and explained on the drug package insert [17]. Age -specific groups were classified into newborn (0–1 month), infant (1–23 months), preschool child (2–5 years), child (6–12 years), and adolescent (13–17 years, including 17 years) [18]. When a suspected ADR is reported more frequently on the combination of two drugs as compared with the situation where these drugs are used in the absence of each other, this association might indicate the existence of a drug-drug interaction (DDI) [19], [20]. By patient reporting we mean a slightly adapted version of the van Grootheest definition: ‘users of drugs (or their parents or cares) reporting suspected ADRs directly to a spontaneous reporting system [21].

Data Split

ADR report may contain one or more drugs and ADRs. In this study, all drug-event pairs, whether the role of the drug of interest was considered ‘suspect’ or ‘concomitant’, was included and the calculation was based on the counts of drug-event pairs in the analysis.

Data Analyses

Categorical data were compared by Chi-square test, and ranked data by Cochran-Mantel-Haenszel test. Fisher’s exact test was used when numerators were small number. Odds ratios (ORs) and 95% confidence intervals (CIs) between the rates of new ADRs report in different reporters were calculated using Logistic Regression. Only two-tailed tests were used. A P-value of 0.05 or less was considered to be significant and statistical analyses were performed using SAS 9.3 software (SAS Institute, Cary, NC, USA).

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Results

A total of 24292 reports were submitted to Shanghai SRS in 2009, and 3945 reports concerning children 0–17 years (including 17 years) were retrieved from the system. Of the 3945 reports, 97 were deleted from our analyses for the following reasons: drug administration was to the mother (n=1); out-of-range age (n=86); no suspected ADR (n=9); or no suspected drug (n=1). In total, we examined 3848 reports of suspected pediatric ADRs that were reported to the Adverse Drug Reaction Monitoring Center of Shanghai during the study period.

The 3848 reports included 4430 suspected ADRs, with an average of over 10 reports per day and 1.15 ADRs per child. There were 666 reports, which cited more than one suspected drug (Table 1). The total number of suspected drugs in pediatric reports was 4619 with a mean number of 1.20 drugs per child.

Table 1

Number of suspected drugs per ADRs report.

ADRs by Age and Gender

The age- and gender-specific prevalence of ADRs was presented in Fig. 1. In general, a total of 1790 ADRs (40.41%) and 2640 ADRs (59.59%) were reported for female and male patients, respectively. More ADRs were reported for boys than girls except the 0–1 month group. When the data were assessed in terms of age groups, almost two thirds of ADRs were reported for children from birth to 5 years of age (65.01%) and 39.46% concerned children aging 2 months-2 years (Fig. 1). Table 2 showed the number of serious ADRs report of different age groups. The highest proportion (6.58%) of serious reports was reported for newborn (0–1 month). A total of 110 serious ADRs were detected in our analysis with 57 (2.16%) in male patients and 53 (2.96%) in female patients. No statistically significant difference was observed between boys and girls by Fisher exact test (P=0.095, two sided test of proportions).

Figure 1

Age- and gender-specific prevalence of ADRs based on the data from Shanghai SRS (2009).

Table 2

Number of ADRs reports by age and severity category.

ADRs by Vaccines and Non-vaccines

The single most common reaction was exanthema, followed by fever, application site reaction and vomiting (Table 3). Regarding assessment of drugs, the most frequent reports were related to vaccine use (1622 reports, 42.15%). When the non-vaccine related reports were discriminated by excluding children that had been reported to have a suspected ADR of a vaccination, the total number of children, whom an ADR had been related to, were then reduced to 2649. Skin reactions were still most frequently reported. The most commonly reported drugs among serious reports were antibacterials for systemic use (32.82%), nervous system (17.56%) and vaccines (13.74%). When drugs were assessed, cefuroxime (382 reports), azithromycin (340 reports) and cefotiam (130 reports) were the most frequently reported non-vaccine related drugs. When assessing the serious ADRs, the frequency of the non-vaccine related increased to 83.64%, the most frequently reported non-vaccine drugs were ceftriaxone (9 reports), cefuroxime (7 reports) and lamotrigine (7 reports).

Table 3

Ten most frequently reported ADRs.

Multiple Drug Exposure and Serious ADRs

Among the total 3848 ADRs reports, there were 3182 single drug use and 666 multiple drug exposure reports (Table 1). Two point forty-eight percent (110/4430) of the adverse drug reactions were reported as serious reactions (48 new serious ADRs). The most frequently reported serious reactions were Anaphylactic Shock (17 reports, 15.45%) followed by exanthema (11 reports, 10.00%). Fifty-five (1.73%) and 28 (4.20%) reports in single drug use and multiple drug exposure, respectively, were registered as serious. It seemed that multiple drug exposure experienced a high proportion of serious ADRs compared with the single drug use (χ²=15.99, P<0.0001, two sided test of proportions).

Outcomes of ADRs Reports

Of all 3848 children, 1176 (30.56%), 2655(69.00%), 4(0.10%), 13(0.34%) children were reported to be cured, getting better, recovering with sequelae, and death, respectively (Table 4). Vaccine accounted for 50% of these cases, and others were central nervous system agents. The fraction of non-vaccine related reports with total recovery of the patients was 30.10% (670) and 69.45% (1546) of children were getting better. Two children had recovered with sequelae of non-vaccine related reports. There were 13 drug related deaths, with 8 of non-vaccine and 5 vaccine related reports (Table 5).

Table 4

Outcomes resulting from ADR Reports.

Table 5

Reported adverse drug reactions (ADRs) in children leading to death.

ADRs by Type of Reporter and Severity

Analysis of the ADR reports for children received in 2009 of spontaneous reporting system (SRS) of Shanghai showed that 9.68% (429) of the suspected ADRs were described as new to the Agency, of which 381 ADRs were general and 48 ADRs were serious. There were 52.03% (2002 reports), 24.27% (934 reports) and 15.46% (595 reports) of reports from physicians, pharmacists and other HCPs, respectively. For the total 3848 reports, Spontaneous reports from consumers (like patients themselves or their parents) appear to contribute a relatively small percentage of total reports (2.52%, 97 reports). Nearly 5.72% (220) of reporters did not give their occupations. The difference on distributions of severity between different reporters was not statistically significant (χ²_CMH=3.09, P=0.377). However, it was concluded that the sources of reports might have a difference between new and traditional ADRs (χ²_CMH=22.45, P<0.0001). When compared with reports from other HCPs, consumers were more likely to report new ADRs (OR=5.06, 95% CI 1.84 to 13.94, Table 6).

Table 6

The Logistic regression results of different reporters (new or traditional ADRs).

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Discussion

In our study, more than 50% of the ADRs were reported for children from birth to 5 years of age and almost 40% concerned children between 2 months and 2 years of age. Similar findings were observed in other studies [22], [23], [24]. Several reasons might contribute to the higher reporting rates in young children. Firstly, young children are more closely monitored by physicians and parents. Secondly, a large number of ADRs reported in this age group may also be due to the widely use of off-label and unlicensed drugs. Thirdly, Children under 5 were the most common age group for vaccination. The ADR rate causes by vaccine is much higher than other drugs, and this may be related to the types and number of vaccination being used in China, as the types of routine immunization vaccines in China reach up to 15 kinds, which is much higher than 7 kinds in India and Vietnam, 9 kinds in Thailand and 11 kinds in America, and most of the vaccines in China are attenuated live vaccines, which may bring greater potential safety hazard. In addition, previous studies suggested an increased risk of ADRs for drugs used off-label [25], [26], [27]. This was an important issue regarding children’s health risk. Some studies in adults demonstrated that female patients were more prone to develop ADRs than male patients whereas other studies did not [28], [29]. However, a recent pediatric study published in 2011 found that a high proportion of ADR reports among children were for boys [30]. For our research, there seems to be an overrepresentation of male patients in the ADR reports except the 0–1 month group, which is consistent with Star’s finding [30]. This may be explained by more attention being paid to ADRs in males than females in some parts of China or it is an indication that male patients truly suffer more often from ADRs than female ones. Further investigations are needed to explain this finding.

In the present survey, skin reactions were the most frequently reported ADRs, regardless of including or excluding of vaccine-related reports. And this is consistent with previous findings [23], [31]. Antibiotics were the most frequently reported pharmacological group of drugs in previous studies in contrast to our study where vaccines were most commonly reported [31], [32], [33]. This difference might be due to the occurrence of Type A H1N1 influenza in China this year, and HCPs or parents paid close attention to children who got flu vaccine to prevent the influenza. Our study showed that the majority of the children recovered without sequelae and about 1.04% recovered with sequelae. Vaccines were associated with the highest number of Children that recovered with sequelae, followed by central nervous system agents.

With the seemingly constant flow of new therapeutic agents and new treatment indications for existing medications, polypharmacy is increasingly common [34], [35]. Drug-drug interactions (DDI) occur when two or more drugs are taken in combination and one drug influences the effects of another drug. This may subsequently cause a change in the pharmacodynamic or pharmacokinetic parameters which may lead to lack of efficacy, or to an increase in the number of reported adverse drug reactions. The association between multiple drug exposure and the incidence of ADRs has been studied, consistently showing an exponentially increased risk with the increase of the number of drugs taken [36], [37]. When assessing the severity of the reported ADRs, our study confirmed that multiple drug exposure experienced a high proportion compared with the single drug use. This finding indicate that in order to minimize the risk of serious ADRs, HCPs should pay particular attention to children who are prescribed two drugs or more.

The majority of ADRs in children were reported by physicians, and equal shares of serious ADRs were reported by physicians, pharmacists, other HCPs and consumers. This was different with studies of other countries [22], [33]. Previous founding suggested that patients’ reports were more likely to be serious ADRs than health professional reports [38]. In our study, there were just a small proportion of reports from patients themselves or their parents, but they might report more new ADRs. The importance of patient reporting in not only contributing to ‘signal generation’ but also providing data on ‘adverse changes in the quality of life which can be very important, real and distressing to the medicine user yet are unlikely to be clear to a prescriber’ was also highlighted [39]. Patient reporting of suspected ADRs in Shanghai should be encouraged and their reports should be taken as seriously as reports from other sources.

There is so little known of ADRs in the Chinese population, especially for the children. Our study analyzed information reported to Shanghai ADR database on ADRs in pediatric population, and in conclusion, a male overrepresentation was observed regarding the total number of reports, most ADRs were for children less than 6 years of age, the multiple drug exposure experienced a high proportion of serious ADRs, and consumers just contributed a limited number of ADR reports. There were also several limitations of this study. We just evaluated ADRs in children reported to the SRS of Shanghai in 2009, in order to achieve better understanding the characteristics of ADRs in pediatric population more researches are needed. Substantial underreporting of ADRs is a well-known phenomenon, which makes it difficult to estimate the ADR incidence for pediatric patients. In this study, the results suggest that 2.16% of all ADRs were severe, and 0.34% were fatal. However, the true proportion is likely to be much lower than this because severe reactions are much more likely to be reported. We recommend more prospective investigations in outpatient and inpatient settings to better estimate the type and incidence of ADRs in Chinese children.

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Acknowledgments

We are indebted to the Adverse Drug Reaction Monitoring Center of Shanghai, who contributed the data.

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Funding Statement

This study was funded by three grants from the National Natural Science Foundation of China (No. 81072388, No. 81202285, No. 81373105), the key discipline construction of evidence-based public health in Shanghai (No. 12GWZX0602) and Natural Science Foundation of Shanghai (No. 12ZR1453700). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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References

1. Van Puijenbroek EP, Egberts AC, Meyboom RH, Leufkens HG (1999) Signalling possible drug-drug interactions in a spontaneous reporting system: delay of withdrawal bleeding during concomitant use of oral contraceptives and itraconazole. Br J Clin Pharmacol 47: 689–693. [PMC free article] [PubMed]

2. Kongkaew C, Noyce PR, Ashcroft DM (2008) Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother 42: 1017–1025. [PubMed]

3. Pirmohamed M, James S, Meakin S, Green C, Scott AK, et al. (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329: 15–19. [PMC free article] [PubMed]

4. Smyth RM, Gargon E, Kirkham J, Cresswell L, Golder S, et al. (2012) Adverse drug reactions in children–a systematic review. PLoS One 7: e24061. [PMC free article] [PubMed]

5. Lacoste-Roussillon C, Pouyanne P, Haramburu F, Miremont G, Begaud B (2001) Incidence of serious adverse drug reactions in general practice: a prospective study. Clin Pharmacol Ther 69: 458–462. [PubMed]

6. Easton KL, Chapman CB, Brien JA (2004) Frequency and characteristics of hospital admissions associated with drug-related problems in paediatrics. Br J Clin Pharmacol 57: 611–615. [PMC free article] [PubMed]

7. Impicciatore P, Choonara I, Clarkson A, Provasi D, Pandolfini C, et al. (2001) Incidence of adverse drug reactions in paediatric in/out-patients: a systematic review and meta-analysis of prospective studies. Br J Clin Pharmacol 52: 77–83. [PMC free article] [PubMed]

8. Sturkenboom MC, Verhamme KM, Nicolosi A, Murray ML, Neubert A, et al. (2008) Drug use in children: cohort study in three European countries. BMJ 337: a2245. [PMC free article] [PubMed]

9. Sammons HM, Choonara I (2005) Clinical trials of medication in children, 1996–2002. Eur J Clin Pharmacol 61: 165–167. [PubMed]

10. Conroy S, McIntyre J, Choonara I, Stephenson T (2000) Drug trials in children: problems and the way forward. Br J Clin Pharmacol 49: 93–97. [PMC free article] [PubMed]

11. Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 279: 1200–1205. [PubMed]

12. Temple ME, Robinson RF, Miller JC, Hayes JR, Nahata MC (2004) Frequency and preventability of adverse drug reactions in paediatric patients. Drug Saf 27: 819–829. [PubMed]

13. Clavenna A, Berti A, Gualandi L, Rossi E, De Rosa M, et al. (2009) Drug utilisation profile in the Italian paediatric population. Eur J Pediatr 168: 173–180. [PubMed]

14. Wysowski DK, Swartz L (2005) Adverse drug event surveillance and drug withdrawals in the United States, 1969–2002: the importance of reporting suspected reactions. Arch Intern Med 165: 1363–1369. [PubMed]

15. Wiholm B-E, Olsson S, Moore N, Waller P (2000) Spontaneous reporting systems outside the US. In: Strom BL, editor. Pharmacoepidemiology. 3rd ed. Chichester: John Wiley & Sons, Chichester, UK. 175–192.

16. Committee of Chinese Pharmacopoeia (2005) Chinese Pharmacopoeia. Peking: Chemical Industry Press.

17. Ministry of Health of The People’s Republic of China (2011) Measures for the Reporting and Monitoring of Adverse Drug Reactions definitions. Available: http://www.sfda.gov.cn/WS01/CL0053/62621.htmlAccessed 2012 May 17.

18. Wallerstedt SM, Brunlof G, Sundstrom A (2011) Rates of spontaneous reports of adverse drug reactions for drugs reported in children: a cross-sectional study with data from the Swedish adverse drug reaction database and the Swedish Prescribed Drug Register. Drug Saf 34: 669–682. [PubMed]

19. Noren GN, Sundberg R, Bate A, Edwards IR (2008) A statistical methodology for drug-drug interaction surveillance. Stat Med 27: 3057–3070. [PubMed]

20. Thakrar BT, Grundschober SB, Doessegger L (2007) Detecting signals of drug-drug interactions in a spontaneous reports database. Br J Clin Pharmacol 64: 489–495. [PMC free article] [PubMed]

21. van Grootheest K, de Graaf L, de Jong-van den Berg LT (2003) Consumer adverse drug reaction reporting: a new step in pharmacovigilance Drug Saf. 26: 211–217. [PubMed]

22. Aagaard L, Weber CB, Hansen EH (2010) Adverse drug reactions in the paediatric population in Denmark: a retrospective analysis of reports made to the Danish Medicines Agency from 1998 to 2007. Drug Saf 33: 327–339. [PubMed]

23. Kimland E, Rane A, Ufer M, Panagiotidis G (2005) Paediatric adverse drug reactions reported in Sweden from 1987 to 2001. Pharmacoepidemiol Drug Saf 14: 493–499. [PubMed]

24. Carleton BC, Smith MA, Gelin MN, Heathcote SC (2007) Paediatric adverse drug reaction reporting: understanding and future directions. Can J Clin Pharmacol 14: e45–57. [PubMed]

25. Horen B, Montastruc JL, Lapeyre-Mestre M (2002) Adverse drug reactions and off-label drug use in paediatric outpatients. Br J Clin Pharmacol 54: 665–670. [PMC free article] [PubMed]

26. Choonara I, Conroy S (2002) Unlicensed and off-label drug use in children: implications for safety. Drug Saf 25: 1–5. [PubMed]

27. Jain SS, Bavdekar SB, Gogtay NJ, Sadawarte PA (2008) Off-label drug use in children. Indian J Pediatr 75: 1133–1136. [PubMed]

28. Fattinger K, Roos M, Vergeres P, Holenstein C, Kind B, et al. (2000) Epidemiology of drug exposure and adverse drug reactions in two swiss departments of internal medicine. Br J Clin Pharmacol 49: 158–167. [PMC free article] [PubMed]

29. Sanchez Munoz-Torrero JF, Barquilla P, Velasco R, Fernandez Capitan Mdel C, Pacheco N, et al. (2010) Adverse drug reactions in internal medicine units and associated risk factors. Eur J Clin Pharmacol 66: 1257–1264. [PubMed]

30. Star K, Noren GN, Nordin K, Edwards IR (2011) Suspected adverse drug reactions reported for children worldwide: an exploratory study using VigiBase. Drug Saf 34: 415–428. [PubMed]

31. Morales-Olivas FJ, Martinez-Mir I, Ferrer JM, Rubio E, Palop V (2000) Adverse drug reactions in children reported by means of the yellow card in Spain. J Clin Epidemiol 53: 1076–1080. [PubMed]

32. Le J, Nguyen T, Law AV, Hodding J (2006) Adverse drug reactions among children over a 10-year period. Pediatrics 118: 555–562. [PubMed]

33. Hawcutt DB, Mainie P, Riordan A, Smyth RL, Pirmohamed M (2011) Reported paediatric adverse drug reactions in the UK 2000–2009. Br J Clin Pharmacol 73: 437–446. [PMC free article] [PubMed]

34. Rambhade S, Chakarborty A, Shrivastava A, Patil UK, Rambhade A (2012) A survey on polypharmacy and use of inappropriate medications. Toxicol Int 19: 68–73. [PMC free article] [PubMed]

35. Koh NY, Koo WH (2002) Polypharmacy in palliative care: can it be reduced? Singapore Med J 43: 279–283. [PubMed]

36. Zopf Y, Rabe C, Neubert A, Hahn EG, Dormann H (2008) Risk factors associated with adverse drug reactions following hospital admission: a prospective analysis of 907 patients in two German university hospitals. Drug Saf 31: 789–798. [PubMed]

37. Rashed AN, Wong IC, Cranswick N, Tomlin S, Rascher W, et al. (2012) Risk factors associated with adverse drug reactions in hospitalised children: international multicentre study. Eur J Clin Pharmacol 68: 801–810. [PubMed]

38. van Grootheest AC, Passier JL, van Puijenbroek EP (2005) [Direct reporting of side effects by the patient: favourable experience in the first year]. Ned Tijdschr Geneeskd 149: 529–533. [PubMed]

39. KILEN (2000) Consumer Reports on Medicines–Consensus Document. Available: http://www.kilen.org/indexe.htmAccessed 2012 May 17.

Military Personnal Purged By President Obama

When they left they took with them information critical to the functioning of the US military - such as how things work, who has the Nuclear Launch Sequence Repair Kits. Etc.

It appears that Pres Obama wants this nation destroyed in one bug huge Nuke War - there can be no other conclusions.

Here is the list of our military elite who have been purged or fired under Obama:

Commanding Generals fired:
· General John R. Allen-U.S. Marines Commander International Security Assistance Force [ISAF] (Nov 2012)
· Major General Ralph Baker (2 Star)-U.S. Army Commander of the Combined Joint Task Force Horn in Africa (April 2013)
· Major General Michael Carey (2 Star)-U.S. Air Force Commander of the 20th US Air Force in charge of 9,600 people and 450 Intercontinental Ballistic Missiles (Oct 2013)
· Colonel James Christmas-U.S. Marines Commander 22nd Marine Expeditionary Unit & Commander Special-Purpose Marine Air-Ground Task Force Crisis Response Unit (July 2013)
· Major General Peter Fuller-U.S. Army Commander in Afghanistan (May 2011)
· Major General Charles M.M. Gurganus-U.S. Marine Corps Regional Commander of SW and I Marine Expeditionary Force in Afghanistan (Oct 2013)
· General Carter F. Ham-U.S. Army African Command (Oct 2013)
· Lieutenant General David H. Huntoon (3 Star), Jr.-U.S. Army 58th Superintendent of the US Military Academy at West Point , NY (2013)
· Command Sergeant Major Don B Jordan-U.S. Army 143rd Expeditionary Sustainment Command (suspended Oct 2013)
· General James Mattis-U.S. Marines Chief of CentCom (May 2013)
· Colonel Daren Margolin-U.S. Marine in charge of Quantico 's Security Battalion (Oct 2013)
· General Stanley McChrystal-U.S. Army Commander Afghanistan (June 2010)
· General David D. McKiernan-U.S. Army Commander Afghanistan (2009)
· General David Petraeus-Director of CIA from September 2011 to November 2012 & U.S. Army Commander International Security Assistance Force [ISAF] and Commander U.S. Forces Afghanistan [USFOR-A] (Nov 2012)
· Brigadier General Bryan Roberts-U.S. Army Commander 2nd Brigade (May 2013)
· Major General Gregg A. Sturdevant-U.S. Marine Corps Director of Strategic Planning and Policy for the U.S. Pacific Command & Commander of Aviation Wing at Camp Bastion, Afghanistan (Sept 2013)
· Colonel Eric Tilley-U.S. Army Commander of Garrison Japan (Nov 2013)
· Brigadier General Bryan Wampler-U.S. Army Commanding General of 143rd Expeditionary Sustainment Command of the 1st Theater Sustainment Command [TSC] (suspended Oct 2013)

Commanding Admirals fired:
· Rear Admiral Charles Gaouette-U.S. Navy Commander John C. Stennis Carrier Strike Group Three (Oct 2012)
· Vice Admiral Tim Giardina(3 Star, demoted to 2 Star)-U.S. Navy Deputy Commander of the US Strategic Command, Commander of the Submarine Group Trident, Submarine Group 9 and Submarine Group 10 (Oct 2013)
Naval Officers fired: (All in 2011)
· Captain David Geisler-U.S. Navy Commander Task Force 53 in Bahrain (Oct 2011)
· Commander Laredo Bell-U.S. Navy Commander Naval Support Activity Saratoga Springs , NY (Aug 2011)
· Lieutenant Commander Kurt Boenisch-Executive Officer amphibious transport dock Ponce (Apr 2011)
· Commander Nathan Borchers-U.S. Navy Commander destroyer Stout (Mar 2011)
· Commander Robert Brown-U.S. Navy Commander Beachmaster Unit 2 Fort Story , VA (Aug 2011)
· Commander Andrew Crowe-Executive Officer Navy Region Center Singapore (Apr 2011)
· Captain Robert Gamberg-Executive Officer carrier Dwight D. Eisenhower (Jun 2011)
· Captain Rex Guinn-U.S. Navy Commander Navy Legal Service office Japan (Feb 2011)
· Commander Kevin Harms- U.S. Navy Commander Strike Fighter Squadron 137 aboard the aircraft carrier Abraham Lincoln (Mar 2011)
· Lieutenant Commander Martin Holguin-U.S. Navy Commander mine countermeasures Fearless (Oct 2011)
· Captain Owen Honors-U.S. Navy Commander aircraft carrier USS Enterprise (Jan 2011)
· Captain Donald Hornbeck-U.S. Navy Commander Destroyer Squadron 1 San Diego
(Apr 2011)
· Rear Admiral Ron Horton-U.S. Navy Commander Logistics Group, Western Pacific
(Mar 2011)
· Commander Etta Jones-U.S. Navy Commander amphibious transport dock Ponce (Apr 2011)
· Commander Ralph Jones-Executive Officer amphibious transport dock Green Bay (Jul 2011)
· Commander Jonathan Jackson-U.S. Navy Commander Electronic Attack Squadron 134, deployed aboard carrier Carl Vinson (Dec 2011)
· Captain Eric Merrill-U.S. Navy Commander submarine Emory S. Land (Jul 2011)
· Captain William Mosk-U.S. Navy Commander Naval Station Rota , U.S. Navy Commander Naval Activities Spain (Apr 2011)
· Commander Timothy Murphy-U.S. Navy Commander Electronic Attack Squadron 129 at Naval Air Station Whidbey Island , WA (Apr 2011)
· Commander Joseph Nosse-U.S. Navy Commander ballistic-missile submarine Kentucky (Oct 2011)
· Commander Mark Olson-U.S. Navy Commander destroyer The Sullivans FL (Sep 2011)
· Commander John Pethel-Executive Officer amphibious transport dock New York (Dec 2011)
· Commander Karl Pugh-U.S. Navy Commander Electronic Attack Squadron 141 Whidbey Island , WA (Jul 2011)
· Commander Jason Strength-U.S. Navy Commander of Navy Recruiting District Nashville , TN (Jul 2011)
· Captain Greg Thomas-U.S. Navy Commander Norfolk Naval Shipyard (May 2011)
· Commander Mike Varney-U.S. Navy Commander attack submarine Connecticut (Jun 2011)
· Commander Jay Wylie-U.S. Navy Commander destroyer Momsen (Apr 2011)
Naval Officers fired: (All in 2012):
· Commander Alan C. Aber-Executive Officer Helicopter Maritime Strike Squadron 71 (July 2012)
· Commander Derick Armstrong- U.S. Navy Commander missile destroyer USS The Sullivans (May 2012)
· Commander Martin Arriola- U.S. Navy Commander destroyer USS Porter (Aug 2012)
· Captain Antonio Cardoso- U.S. Navy Commander Training Support Center San Diego (Sep 2012)
· Captain James CoBell- U.S. Navy Commander Oceana Naval Air Station's Fleet Readiness Center Mid-Atlantic (Sep 2012)
· Captain Joseph E. Darlak- U.S. Navy Commander frigate USS Vandegrift (Nov 2012)
· Captain Daniel Dusek-U.S. Navy Commander USS Bonhomme
· Commander David Faught-Executive Officer destroyer Chung-Hoon (Sep 2012)
· Commander Franklin Fernandez- U.S. Navy Commander Naval Mobile Construction Battalion 24 (Aug 2012)
· Commander Ray Hartman- U.S. Navy Commander Amphibious dock-landing ship Fort McHenry (Nov 2012)
· Commander Shelly Hakspiel-Executive Officer Navy Drug Screening Lab San Diego (May 2012)
· Commander Jon Haydel- U.S. Navy Commander USS San Diego (Mar 2012)
· Commander Diego Hernandez- U.S. Navy Commander ballistic-missile submarine USS Wyoming (Feb 2012)
· Commander Lee Hoey- U.S. Navy Commander Drug Screening Laboratory, San Diego (May 2012)
· Commander Ivan Jimenez-Executive Officer frigate Vandegrift (Nov 2012)
· Commander Dennis Klein- U.S. Navy Commander submarine USS Columbia (May 2012)
· Captain Chuck Litchfield- U.S. Navy Commander assault ship USS Essex (Jun 2012)
· Captain Marcia Kim Lyons- U.S. Navy Commander Naval Health Clinic New England (Apr 2012)
· Captain Robert Marin- U.S. Navy Commander cruiser USS Cowpens (Feb 2012)
· Captain Sean McDonell- U.S. Navy Commander Seabee reserve unit Naval Mobile Construction Battalion 14 FL (Nov 2012)
· Commander Corrine Parker- U.S. Navy Commander Fleet Logistics Support Squadron 1 (Apr 2012)
· Captain Liza Raimondo- U.S. Navy Commander Naval Health Clinic Patuxent River , MD (Jun 2012)
· Captain Jeffrey Riedel- Program manager, Littoral Combat Ship program (Jan 2012)
· Commander Sara Santoski- U.S. Navy Commander Helicopter Mine Countermeasures Squadron 15 (Sep 2012)
· Commander Kyle G. Strudthoff-Executive Officer Helicopter Sea Combat Squadron 25 (Sep 2012)
· Commander Sheryl Tannahill- U.S. Navy Commander Navy Operational Support Center [NOSC] Nashville , TN (Sep 2012)
· Commander Michael Ward- U.S. Navy Commander submarine USS Pittsburgh (Aug 2012)
· Captain Michael Wiegand- U.S. Navy Commander Southwest Regional Maintenance Center (Nov 2012)
· Captain Ted Williams- U.S. Navy Commander amphibious command ship Mount Whitney (Nov 2012)
· Commander Jeffrey Wissel- U.S. Navy Commander of Fleet Air Reconnaissance Squadron 1 (Feb 2012)
Naval Officers fired: (All in 2013):
· Lieutenant Commander Lauren Allen-Executive Officer submarine Jacksonville (Feb 2013)
· Reserve Captain Jay Bowman-U.S. Navy Commander Navy Operational Support Center [NOSC] Fort Dix , NJ (Mar 2013)
· Captain William Cogar-U.S. Navy Commander hospital ship Mercy's medical treatment facility (Sept 2013)
· Commander Steve Fuller-Executive Officer frigate Kauffman (Mar 2013)
· Captain Shawn Hendricks-Program Manager for naval enterprise IT networks (June 2013)
· Captain David Hunter-U.S. Navy Commander of Maritime Expeditionary Security Squadron 12 & Coastal Riverine Group 2 (Feb 2013)
· Captain Eric Johnson-U.S. Navy Chief of Military Entrance Processing Command at Great Lakes Naval Training Center, IL (2013)
· Captain Devon Jones-U.S. Navy Commander Naval Air Facility El Centro , CA (July 2013)
· Captain Kevin Knoop-U.S. Navy Commander hospital ship Comfort's medical treatment facility (Aug 2013)
· Lieutenant Commander Jack O'Neill-U.S. Navy Commander Operational Support Center Rock Island , IL (Mar 2013)
· Commander Allen Maestas-Executive Officer Beachmaster Unit 1 (May 2013)
· Commander Luis Molina-U.S. Navy Commander submarine Pasadena (Jan 2013)
· Commander James Pickens-Executive Officer frigate Gary (Feb 2013)
· Lieutenant Commander Mark Rice-U.S. Navy Commander Mine Countermeasures ship Guardian (Apr 2013)
· Commander Michael Runkle-U.S. Navy Commander of Mobile Diving and Salvage Unit 2 (May 2013)
· Commander Jason Stapleton-Executive Office Patrol Squadron 4 in Hawaii (Mar 2013)
· Commander Nathan Sukols-U.S. Navy Commander submarine Jacksonville (Feb 2013)
· Lieutenant Daniel Tyler-Executive Officer Mine Countermeasures ship Guardian (Apr 2013)
· Commander Edward White-U.S. Navy Commander Strike Fighter Squadron 106 (Aug 2013)
· Captain Jeffrey Winter-U.S. Navy Commander of Carrier Air Wing 17 (Sept 2013)
· Commander Thomas Winter-U.S. Navy Commander submarine Montpelier (Jan 2013)
· Commander Corey Wofford- U.S. Navy Commander frigate Kauffman (Feb 2013)

Since Barack Obama has been in the White House, high ranking military officers have been removed from their positions at a rate that is absolutely unprecedented. Things have gotten so bad that a number of retired generals are publicly speaking out about the 'purg' of the U.S. military that they believe is taking place. As you will see below, dozens of highly decorated military leaders have been dismissed from their positions over the past few years. So why is this happening? What is going on right now is absolutely crazy especially during a time of peace. Is there a deliberate attempt to reshape the military and remove those who don't adhere to the proper 'viewpoints' ? Does someone out there feel a need to get officers that won't cooperate out of the way?
Throughout world history, whatever comes next after a military purge is never good.
If this continues, what is the U.S. military going to look like in a few years?
Perhaps you are reading this and you think that 'purge' is too strong a word for what is taking place. Well, just consider the following quotes from some very highly decorated retired officers:
-Retired Army Major General Paul Vallely: The White House protects their own. That's why they stalled on the investigation into fast and furious, Benghazi and Obamacare. He's intentionally weakening and gutting our military, Pentagon and reducing us as a superpower, and anyone in the ranks who disagrees or speaks out is being purged.
-Retired Army Major General Patrick Brady: There is no doubt he (Obama) is intent on emasculating the military and will fire anyone who disagrees with him.
-Retired Army Lt. General William G. Jerry Boykin: Over the past three years, it is unprecedented for the number of four-star generals to be relieved of duty, and not necessarily relieved for cause.
-Retired Navy Captain Joseph John: I believe there are more than 137 officers who have been forced out or given bad evaluation reports so they will never make Flag (officer), because of their failure to comply to certain views.
A Pentagon official who asked to remain nameless because they were not authorized to speak on the matter said even young officers, down through the ranks have been told not to talk about Obama or the politics of the White House. They are purging everyone and if you want to keep your job just keep your mouth shut. Now this trend appears to be accelerating.
http://endoftheamericandream.com/archives/why-are-dozens-of-high-ranking-officers-being-purged-from-the-u-s-military <http://endoftheamericandream.com/archives/why-are-dozens-of-high-ranking-officers-being-purged-from-the-u-s-military>
General Vallely's comment:
Absolutely every communist regime on the planet did this as soon as they got in power. I am surprised this communist traitor with his feet up on our furniture in the white house hasn't done this until now!
SO WHAT ARE YOU GOING TO DO ABOUT IT?
I am doing my part. How about forwarding this.
Paul
(General Paul Vallely)

Dr William B. Mount

US Declares War On China

About a week ago the US Corporate President, under orders form his Superiors in the IMF, has declared an economic war on China.

Please remember that the United States Corporation is solely owned by the IMF (USC2, Sec 286) and that we the American People have no idea what this corporate governing body is up to.

Let it also be said that under USC 5, Sec 103 the only department run by Pres Obama is Homeland Security. The DOD is solely owned, and controlled, by the IMF.

The IMF is 54.5% owned by David Rothchilds.

The Rothchilds work for the Roman Pope, who answers to the Great White Brotherhood of Lucifer's Sons - the Asherons.

So we, the American People, are being hung out to dry by these Lucifarian Scum.

Just like the Tall Whites, the Short Greys, blues, purples, and all other Boogie Men from outer space - our DNA is being screwed with also.

1) Hollywood Land: A Note to the Mainstream Media: TV watching is down by 50% over the last 6 years. You are about to be hit with huge budget cuts as fewer and fewer people actually watch your garbage. Can we say: Economic Earth Quake Hollywood?

2) BANKSTAS: Your seven years is up. You stole my money and never returned it. Now the King of Kings and Lord of Lords has given Lucifer permission to kill you. You will now die in droves, so HE has spoken, so it shall be.

3) DHS (NAZI SS) protect the president. Ensure that the lowest level software (Environmental Controls) is now corrupted and check and recheck the Right Rear Engine on the President's Tertiary Jet.

Now: Pres Obama declares war by executive order on China:


http://beforeitsnews.com/alternative/2014/03/breaking-war-secretly-declared-on-china-by-executive-order-2913964.html

http://www.youtube.com/watch?v=tC9WAf3NqHY#t=15

Executive Order -- Blocking Property of Certain Persons Contributing to the Situation in Ukraine




EXECUTIVE ORDER

- - - - - - -

BLOCKING PROPERTY OF CERTAIN PERSONS CONTRIBUTING TO THE SITUATION IN UKRAINE

By the authority vested in me as President by the Constitution and the laws of the United States of America, including the International Emergency Economic Powers Act (50 U.S.C. 1701 et seq.) (IEEPA), the National Emergencies Act (50 U.S.C. 1601 et seq.) (NEA), section 212(f) of the Immigration and Nationality Act of 1952 (8 U.S.C. 1182(f)), and section 301 of title 3, United States Code,

I, BARACK OBAMA, President of the United States of America, find that the actions and policies of persons -- including persons who have asserted governmental authority in the Crimean region without the authorization of the Government of Ukraine -- that undermine democratic processes and institutions in Ukraine; threaten its peace, security, stability, sovereignty, and territorial integrity; and contribute to the misappropriation of its assets, constitute an unusual and extraordinary threat to the national security and foreign policy of the United States, and I hereby declare a national emergency to deal with that threat. I hereby order:

Section 1. (a) All property and interests in property that are in the United States, that hereafter come within the United States, or that are or hereafter come within the possession or control of any United States person (including any foreign branch) of the following persons are blocked and may not be transferred, paid, exported, withdrawn, or otherwise dealt in: any person determined by the Secretary of the Treasury, in consultation with the Secretary of State:

(i) to be responsible for or complicit in, or to have engaged in, directly or indirectly, any of the following:

(A) actions or policies that undermine democratic processes or institutions in Ukraine;

(B) actions or policies that threaten the peace, security, stability, sovereignty, or territorial integrity of Ukraine; or

(C) misappropriation of state assets of Ukraine or of an economically significant entity in Ukraine;

(ii) to have asserted governmental authority over any part or region of Ukraine without the authorization of the Government of Ukraine;

(iii) to be a leader of an entity that has, or whose members have, engaged in any activity described in subsection (a)(i) or (a)(ii) of this section or of an entity whose property and interests in property are blocked pursuant to this order;

(iv) to have materially assisted, sponsored, or provided financial, material, or technological support for, or goods or services to or in support of, any activity described in subsection (a)(i) or (a)(ii) of this section or any person whose property and interests in property are blocked pursuant to this order; or

(v) to be owned or controlled by, or to have acted or purported to act for or on behalf of, directly or indirectly, any person whose property and interests in property are blocked pursuant to this order.

(b) The prohibitions in subsection (a) of this section apply except to the extent provided by statutes, or in regulations, orders, directives, or licenses that may be issued pursuant to this order, and notwithstanding any contract entered into or any license or permit granted prior to the effective date of this order.

Sec. 2. I hereby find that the unrestricted immigrant and nonimmigrant entry into the United States of aliens determined to meet one or more of the criteria in subsection 1(a) of this order would be detrimental to the interests of the United States, and I hereby suspend entry into the United States, as immigrants or nonimmigrants, of such persons. Such persons shall be treated as persons covered by section 1 of Proclamation 8693 of July 24, 2011 (Suspension of Entry of Aliens Subject to United Nations Security Council Travel Bans and International Emergency Economic Powers Act Sanctions).

Sec. 3. I hereby determine that the making of donations of the type of articles specified in section 203(b)(2) of IEEPA (50 U.S.C. 1702(b)(2)) by, to, or for the benefit of any person whose property and interests in property are blocked pursuant to section 1 of this order would seriously impair my ability to deal with the national emergency declared in this order, and I hereby prohibit such donations as provided by section 1 of this order.

Sec. 4. The prohibitions in section 1 of this order include but are not limited to:

(a) the making of any contribution or provision of funds, goods, or services by, to, or for the benefit of any person whose property and interests in property are blocked pursuant to this order; and

(b) the receipt of any contribution or provision of funds, goods, or services from any such person.

Sec. 5. (a) Any transaction that evades or avoids, has the purpose of evading or avoiding, causes a violation of, or attempts to violate any of the prohibitions set forth in this order is prohibited.

(b) Any conspiracy formed to violate any of the prohibitions set forth in this order is prohibited.

Sec. 6. For the purposes of this order:

(a) the term "person" means an individual or entity;

(b) the term "entity" means a partnership, association, trust, joint venture, corporation, group, subgroup, or other organization; and

(c) the term "United States person" means any United States citizen, permanent resident alien, entity organized under the laws of the United States or any jurisdiction within the United States (including foreign branches), or any person in the United States.

Sec. 7. For those persons whose property and interests in property are blocked pursuant to this order who might have a constitutional presence in the United States, I find that because of the ability to transfer funds or other assets instantaneously, prior notice to such persons of measures to be taken pursuant to this order would render those measures ineffectual. I therefore determine that for these measures to be effective in addressing the national emergency declared in this order, there need be no prior notice of a listing or determination made pursuant to section 1 of this order.

Sec. 8. The Secretary of the Treasury, in consultation with the Secretary of State, is hereby authorized to take such actions, including the promulgation of rules and regulations, and to employ all powers granted to the President by IEEPA, as may be necessary to carry out the purposes of this order. The Secretary of the Treasury may redelegate any of these functions to other officers and agencies of the United States Government consistent with applicable law. All agencies of the United States Government are hereby directed to take all appropriate measures within their authority to carry out the provisions of this order.

Sec. 9. The Secretary of the Treasury, in consultation with the Secretary of State, is hereby authorized to submit the recurring and final reports to the Congress on the national emergency declared in this order, consistent with section 401(c) of the NEA (50 U.S.C. 1641(c)) and section 204(c) of IEEPA (50 U.S.C. 1703(c)).

Sec. 10. This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

BARACK OBAMA

Obama is Insane: Five US Nuclear Carries in One Port and who has Obama Purged?

Something to keep an eye on.  I would not automatically assume that retired Gen Paul Vallely is a good guy since he has been associated with Satanists. 

However, please note that the ONLY time, ACCORDING TO THE US CONSTITUTION, the President is Commander in Chief is during wartime--war declared by CONGRESS!!!  When was the last time Congress declared war, aside from war on drugs, crime, etc.?  M

 

 

 

---

It's time the US armed forces chucked the

se

Zionists and their Puppets ( Chaney, Bush, Rumsfeld, Obama & Co ) out and took back co

n

trol of their country. A fraud pretend " commander in chief " has no standing or case to run this great country

.

WAKE UP THE UNITED STATES ARMED FORCES.

HOW MUCH MORE ARE WE THE PEOPLE GOING TO STAND FOR ???




What is wrong with this picture?
The picture is of the five first line US nuclear carriers docked together in one place. Just like Battleship Row, Pearl Harbor , December 7, 1941.
This picture was taken the February 2014 in Norfolk , Virginia … Obama ordered 5 nuclear carriers into harbor for "routine" (?) inspections. Heads of the Navy were flabbergasted by the directive but had to comply as it was a direct order from their Commander-in-Chief.

The carriers were all pulled out from the MIDDLE EAST and the Afghanistan support role leaving our land forces naked and exposed!

NORFOLK, VA. (February 8, 2014). This is the first time since WWII that five nuclear powered aircraft carriers were docked together. USS Dwight D. Eisenhower (CVN 69), USS George H.W. Bush (CVN 77), USS Enterprise (CVN 65), USS Harry S. Truman (CVN 75), and USS Abraham Lincoln (CVN 72) are all in port at Naval Station Norfolk , Va. , the world’s largest naval station.

Knowledgeable Sources stated that this breached a long standing military protocol in the Navy meant to avoid a massive enemy strike on major US forces.
(U..S. Navy photo by Chief Mass Communication Specialist Ryan J. Courtade/Released).

Obama is ‘Commander in chief’.
This ordering of most of the Navy's capitol ships into one place is unprecedented since Pearl Harbor !  This could be the creation of a false flag atomic incident too stupid for any enemy to pass up.
--------------------------------------------------------------------------
Also, why did the following happen?  Is this a routine changing of the guard?  Or what?  I'm afraid of the "what"!

Major General Paul Vallely (Ret):This long list of senior military officers and one sergeant major
comes at no great surprise to me because of the direction this
country is heading.  
Here is the list of our military elite who have been purged or fired under Obama:
Commanding Generals fired:· General John R. Allen-U.S. Marines Commander International Security Assistance Force [ISAF] (Nov 2012)
· Major General Ralph Baker (2 Star)-U.S. Army Commander of the Combined Joint Task Force Horn in Africa (April 2013)
· Major General Michael Carey (2 Star)-U.S. Air Force Commander of the 20th US Air Force in charge of 9,600 people and 450 Intercontinental Ballistic Missiles (Oct 2013)
· Colonel James Christmas-U.S. Marines Commander 22nd Marine Expeditionary Unit & Commander Special-Purpose Marine Air-Ground Task Force Crisis Response Unit (July 2013)
· Major General Peter Fuller-U.S. Army Commander in Afghanistan (May 2011)
· Major General Charles M.M. Gurganus-U.S. Marine Corps Regional Commander of SW and I Marine Expeditionary Force in Afghanistan (Oct 2013)
· General Carter F. Ham-U.S. Army African Command (Oct 2013)
· Lieutenant General David H. Huntoon (3 Star), Jr.-U.S. Army 58th Superintendent of the US Military Academy at West Point , NY (2013)
· Command Sergeant Major Don B Jordan-U.S. Army 143rd Expeditionary Sustainment Command (suspended Oct 2013)
· General James Mattis-U.S. Marines Chief of CentCom (May 2013)
· Colonel Daren Margolin-U.S. Marine in charge of Quantico 's Security Battalion (Oct 2013)
· General Stanley McChrystal-U.S. Army Commander Afghanistan (June 2010)
· General David D. McKiernan-U.S. Army Commander Afghanistan (2009)
· General David Petraeus-Director of CIA from September 2011 to November 2012 & U.S. Army Commander International Security Assistance Force [ISAF] and Commander U.S. Forces Afghanistan [USFOR-A] (Nov 2012)
· Brigadier General Bryan Roberts-U.S. Army Commander 2nd Brigade (May 2013)
· Major General Gregg A. Sturdevant-U.S. Marine Corps Director of Strategic Planning and Policy for the U.S. Pacific Command & Commander of Aviation Wing at Camp Bastion, Afghanistan (Sept 2013)
· Colonel Eric Tilley-U.S. Army Commander of Garrison Japan (Nov 2013)
· Brigadier General Bryan Wampler-U.S. Army Commanding General of 143rd Expeditionary Sustainment Command of the 1st Theater Sustainment Command [TSC] (suspended Oct 2013)

Commanding Admirals fired:· Rear Admiral Charles Gaouette-U.S. Navy Commander John C. Stennis Carrier Strike Group Three (Oct 2012)
· Vice Admiral Tim Giardina(3 Star, demoted to 2 Star)-U.S. Navy Deputy Commander of the US Strategic Command, Commander of the Submarine Group Trident, Submarine Group 9 and Submarine Group 10 (Oct 2013)
Naval Officers fired: (All in 2011)· Captain David Geisler-U.S. Navy Commander Task Force 53 in Bahrain (Oct 2011)
· Commander Laredo Bell-U.S. Navy Commander Naval Support Activity Saratoga Springs , NY (Aug 2011)
· Lieutenant Commander Kurt Boenisch-Executive Officer amphibious transport dock Ponce (Apr 2011)
· Commander Nathan Borchers-U.S. Navy Commander destroyer Stout (Mar 2011)
· Commander Robert Brown-U.S. Navy Commander Beachmaster Unit 2 Fort Story , VA (Aug 2011)
· Commander Andrew Crowe-Executive Officer Navy Region Center Singapore (Apr 2011)
· Captain Robert Gamberg-Executive Officer carrier Dwight D. Eisenhower (Jun 2011)
· Captain Rex Guinn-U.S. Navy Commander Navy Legal Service office Japan (Feb 2011)
· Commander Kevin Harms- U.S. Navy Commander Strike Fighter Squadron 137 aboard the aircraft carrier Abraham Lincoln (Mar 2011)
· Lieutenant Commander Martin Holguin-U.S. Navy Commander mine countermeasures Fearless (Oct 2011)
· Captain Owen Honors-U.S. Navy Commander aircraft carrier USS Enterprise (Jan 2011)
· Captain Donald Hornbeck-U.S. Navy Commander Destroyer Squadron 1 San Diego
(Apr 2011)
· Rear Admiral Ron Horton-U.S. Navy Commander Logistics Group, Western Pacific
(Mar 2011)
· Commander Etta Jones-U.S. Navy Commander amphibious transport dock Ponce (Apr 2011)
· Commander Ralph Jones-Executive Officer amphibious transport dock Green Bay (Jul 2011)
· Commander Jonathan Jackson-U.S. Navy Commander Electronic Attack Squadron 134, deployed aboard carrier Carl Vinson (Dec 2011)
· Captain Eric Merrill-U.S. Navy Commander submarine Emory S. Land (Jul 2011)
· Captain William Mosk-U.S. Navy Commander Naval Station Rota , U.S. Navy Commander Naval Activities Spain (Apr 2011)
· Commander Timothy Murphy-U.S. Navy Commander Electronic Attack Squadron 129 at Naval Air Station Whidbey Island , WA (Apr 2011)
· Commander Joseph Nosse-U.S. Navy Commander ballistic-missile submarine Kentucky (Oct 2011)
· Commander Mark Olson-U.S. Navy Commander destroyer The Sullivans FL (Sep 2011)
· Commander John Pethel-Executive Officer amphibious transport dock New York (Dec 2011)
· Commander Karl Pugh-U.S. Navy Commander Electronic Attack Squadron 141 Whidbey Island , WA (Jul 2011)
· Commander Jason Strength-U.S. Navy Commander of Navy Recruiting District Nashville , TN (Jul 2011)
· Captain Greg Thomas-U.S. Navy Commander Norfolk Naval Shipyard (May 2011)
· Commander Mike Varney-U.S. Navy Commander attack submarine Connecticut (Jun 2011)
· Commander Jay Wylie-U.S. Navy Commander destroyer Momsen (Apr 2011)
Naval Officers fired: (All in 2012):
· Commander Alan C. Aber-Executive Officer Helicopter Maritime Strike Squadron 71 (July 2012)
· Commander Derick Armstrong- U.S. Navy Commander missile destroyer USS The Sullivans (May 2012)
· Commander Martin Arriola- U.S. Navy Commander destroyer USS Porter (Aug 2012)
· Captain Antonio Cardoso- U.S. Navy Commander Training Support Center San Diego (Sep 2012)
· Captain James CoBell- U.S. Navy Commander Oceana Naval Air Station's Fleet Readiness Center Mid-Atlantic (Sep 2012)
· Captain Joseph E. Darlak- U.S. Navy Commander frigate USS Vandegrift (Nov 2012)
· Captain Daniel Dusek-U.S. Navy Commander USS Bonhomme
· Commander David Faught-Executive Officer destroyer Chung-Hoon (Sep 2012)
· Commander Franklin Fernandez- U.S. Navy Commander Naval Mobile Construction Battalion 24 (Aug 2012)
· Commander Ray Hartman- U.S. Navy Commander Amphibious dock-landing ship Fort McHenry (Nov 2012)
· Commander Shelly Hakspiel-Executive Officer Navy Drug Screening Lab San Diego (May 2012)
· Commander Jon Haydel- U.S. Navy Commander USS San Diego (Mar 2012)
· Commander Diego Hernandez- U.S. Navy Commander ballistic-missile submarine USS Wyoming (Feb 2012)
· Commander Lee Hoey- U.S. Navy Commander Drug Screening Laboratory, San Diego (May 2012)
· Commander Ivan Jimenez-Executive Officer frigate Vandegrift (Nov 2012)
· Commander Dennis Klein- U.S. Navy Commander submarine USS Columbia (May 2012)
· Captain Chuck Litchfield- U.S. Navy Commander assault ship USS Essex (Jun 2012)
· Captain Marcia Kim Lyons- U.S. Navy Commander Naval Health Clinic New England (Apr 2012)
· Captain Robert Marin- U.S. Navy Commander cruiser USS Cowpens (Feb 2012)
· Captain Sean McDonell- U.S. Navy Commander Seabee reserve unit Naval Mobile Construction Battalion 14 FL (Nov 2012)
· Commander Corrine Parker- U.S. Navy Commander Fleet Logistics Support Squadron 1 (Apr 2012)
· Captain Liza Raimondo- U.S. Navy Commander Naval Health Clinic Patuxent River , MD (Jun 2012)
· Captain Jeffrey Riedel- Program manager, Littoral Combat Ship program (Jan 2012)
· Commander Sara Santoski- U.S. Navy Commander Helicopter Mine Countermeasures Squadron 15 (Sep 2012)
· Commander Kyle G. Strudthoff-Executive Officer Helicopter Sea Combat Squadron 25 (Sep 2012)
· Commander Sheryl Tannahill- U.S. Navy Commander Navy Operational Support Center [NOSC] Nashville , TN (Sep 2012)
· Commander Michael Ward- U.S. Navy Commander submarine USS Pittsburgh (Aug 2012)
· Captain Michael Wiegand- U.S. Navy Commander Southwest Regional Maintenance Center (Nov 2012)
· Captain Ted Williams- U.S. Navy Commander amphibious command ship Mount Whitney (Nov 2012)
· Commander Jeffrey Wissel- U.S. Navy Commander of Fleet Air Reconnaissance Squadron 1 (Feb 2012)
Naval Officers fired: (All in 2013):· Lieutenant Commander Lauren Allen-Executive Officer submarine Jacksonville (Feb 2013)
· Reserve Captain Jay Bowman-U.S. Navy Commander Navy Operational Support Center [NOSC] Fort Dix , NJ (Mar 2013)
· Captain William Cogar-U.S. Navy Commander hospital ship Mercy's medical treatment facility (Sept 2013)
· Commander Steve Fuller-Executive Officer frigate Kauffman (Mar 2013)
· Captain Shawn Hendricks-Program Manager for naval enterprise IT networks (June 2013)
· Captain David Hunter-U.S. Navy Commander of Maritime Expeditionary Security Squadron 12 & Coastal Riverine Group 2 (Feb 2013)
· Captain Eric Johnson-U.S. Navy Chief of Military Entrance Processing Command at Great Lakes Naval Training Center, IL (2013)
· Captain Devon Jones-U.S. Navy Commander Naval Air Facility El Centro , CA (July 2013)
· Captain Kevin Knoop-U.S. Navy Commander hospital ship Comfort's medical treatment facility (Aug 2013)
· Lieutenant Commander Jack O'Neill-U.S. Navy Commander Operational Support Center Rock Island , IL (Mar 2013)
· Commander Allen Maestas-Executive Officer Beachmaster Unit 1 (May 2013)
· Commander Luis Molina-U.S. Navy Commander submarine Pasadena (Jan 2013)
· Commander James Pickens-Executive Officer frigate Gary (Feb 2013)
· Lieutenant Commander Mark Rice-U.S. Navy Commander Mine Countermeasures ship Guardian (Apr 2013)
· Commander Michael Runkle-U.S. Navy Commander of Mobile Diving and Salvage Unit 2 (May 2013)
· Commander Jason Stapleton-Executive Office Patrol Squadron 4 in Hawaii (Mar 2013)
· Commander Nathan Sukols-U.S. Navy Commander submarine Jacksonville (Feb 2013)
· Lieutenant Daniel Tyler-Executive Officer Mine Countermeasures ship Guardian (Apr 2013)
· Commander Edward White-U.S. Navy Commander Strike Fighter Squadron 106 (Aug 2013)
· Captain Jeffrey Winter-U.S. Navy Commander of Carrier Air Wing 17 (Sept 2013)
· Commander Thomas Winter-U.S. Navy Commander submarine Montpelier (Jan 2013)
· Commander Corey Wofford- U.S. Navy Commander frigate Kauffman (Feb 2013)

Since Barack Obama has been in the White House, high ranking military officers have been removed from their positions at a rate that is absolutely unprecedented. Things have gotten so bad that a number of retired generals are publicly speaking out about the 'purg' of the U.S. military that they believe is taking place. As you will see below, dozens of highly decorated military leaders have been dismissed from their positions over the past few years. So why is this happening? What is going on right now is absolutely crazy especially during a time of peace. Is there a deliberate attempt to reshape the military and remove those who don't adhere to the proper 'viewpoints' ? Does someone out there feel a need to get officers that won't cooperate out of the way?
Throughout world history, whatever comes next after a military purge is never good.
If this continues, what is the U.S. military going to look like in a few years?
Perhaps you are reading this and you think that 'purge' is too strong a word for what is taking place. Well, just consider the following quotes from some very highly decorated retired officers:-Retired Army Major General Paul Vallely: The White House protects their own. That's why they stalled on the investigation into fast and furious, Benghazi and Obamacare. He's intentionally weakening and gutting our military, Pentagon and reducing us as a superpower, and anyone in the ranks who disagrees or speaks out is being purged.-Retired Army Major General Patrick Brady: There is no doubt he (Obama) is intent on emasculating the military and will fire anyone who disagrees with him.-Retired Army Lt. General William G. Jerry Boykin: Over the past three years, it is unprecedented for the number of four-star generals to be relieved of duty, and not necessarily relieved for cause.-Retired Navy Captain Joseph John: I believe there are more than 137 officers who have been forced out or given bad evaluation reports so they will never make Flag (officer), because of their failure to comply to certain views.A Pentagon official who asked to remain nameless because they were not authorized to speak on the matter said even young officers, down through the ranks have been told not to talk about Obama or the politics of the White House. They are purging everyone and if you want to keep your job just keep your mouth shut. Now this trend appears to be accelerating.
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General Vallely's comment:Absolutely every communist regime on the planet did this as soon as they got in power.  I am surprised this communist traitor with his feet up on our furniture in the white house hasn't done this until now!
SO WHAT ARE YOU GOING TO DO ABOUT IT?  
I am doing my part.  How about forwarding this.Paul    (General Paul Vallely)