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VAERS

Vaccine Adverse Event Reporting
  1. Patient Information
  2. Vaccine Information
  3. Adverse Event
  4. Medical History
  5. Reporter Information
  6. Review & Submit

Patient Information

Please provide information about the person who received the vaccine and experienced the adverse event.

Privacy Notice: Patient information is protected under federal law. You may leave name and contact fields blank if preferred. However, providing this information helps VAERS follow up if needed.
Patient Demographics

Required to calculate age at vaccination

Contact Information (optional)
VAERS Assistant
Hi! I'm here to help you complete your report. If you have questions about any field or need help finding information, just ask.

About VAERS Modernized

This application is a modernized interface for the Vaccine Adverse Event Reporting System (VAERS).

Workflow

  1. Enter Patient Information
  2. Enter Vaccine Information
  3. Describe Adverse Event
  4. Enter Medical History
  5. Review and Submit
Version: 1.1.1