VAERS - Report an Adverse Event

Report an Adverse Event

Doctor consulting patient on how to report to VAERS

Online reporting is strongly encouraged. Please report clinically important adverse events that occur after vaccination of adults and children, even if you are not sure whether the vaccine caused the adverse event.

The Vaccine Adverse Event Reporting System (VAERS) accepts all reports, including reports of vaccination errors. Guidance on reporting vaccination errors is available if you have additional questions.

Knowingly filing a false VAERS report is a violation of Federal law (18 U.S. Code § 1001) punishable by fine and imprisonment.

Two Ways to Submit an Online Report to VAERS

A woman completing a VAERS report online

Option 1 - Report Online to VAERS (Preferred)

Submit a VAERS report online. The report must be completed online and submitted in one sitting and cannot be saved and returned to at a later time. Your information will be erased if you are inactive for 20 minutes; you will receive a warning after 15 minutes.

Healthcare professional completing a writable PDF form on his computer

Option 2 - Report using a Writable PDF Form

Download the Writable PDF Form to a computer. Complete the VAERS report offline if you do not have time to complete it all at once. Return to this page to upload the completed Writable PDF form by clicking here.

If you need further assistance with reporting to VAERS, please email info@VAERS.org or call 1-800-822-7967.

Checklist

What will I need to fill out the report?

Patient information (age, date of birth, sex)
Vaccine information (brand name, dosage)
Date, time, and location administered
Date and time when adverse event(s) started
Symptoms and outcome of the adverse event(s)
Medical tests and laboratory results (if applicable)
Physician’s contact information (if applicable)

Privacy Protection

Information identifying the person who received the vaccine and the person who filed the report is not made available to the public. You or your health care provider may be contacted for further information after your report is received.

Information supplied in the online submission form is transmitted securely to VAERS. Visit the VAERS Privacy Policies and Disclaimers section for more information about Secure Sockets Layer and data transmission.