Report an Adverse Event
en Español
Please report all significant adverse events that occur after vaccination of adults and children, even if you are not sure whether the vaccine caused the adverse event.
There are three ways to report to VAERS-
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.
Report Online
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Complete a VAERS On-Line Form on this site.
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Before you begin review the Instructions for Completing the VAERS On-Line Form.
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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.
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Report by Fax
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Fax a completed VAERS Form to (877) 721-0366.
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Download the VAERS Form (PDF-98.5 KB).
- Request a VAERS Form by sending e-mail to info@vaers.org, by calling (800) 822-7967, or by faxing a request to (877) 721-0366.
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Before you begin review the Instructions for Completing the VAERS Paper Form.
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Report by Mail
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Mail a completed VAERS Form to VAERS, P.O. Box 1100, Rockville, MD 20849-1100. A pre-paid postage stamp is included on the back of the form.
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Download the VAERS Form (PDF-98.5 KB).
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Request a VAERS form by sending e-mail to info@vaers.org, by calling (800) 822-7967, or by faxing a request to (877) 721-0366.
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Before you begin review the Instructions for Completing the VAERS Paper Form.
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