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DATA The recommended browser is Internet Explorer version 6.0 or higher or Netscape
version 6.0 or higher to submit VAERS data via the Internet.
The Vaccine Adverse Event Reporting System (VAERS) is a cooperative program
VAERS Form for vaccine safety of the Centers for Disease Control and Prevention (CDC) and the
(PDF 23K) Food and Drug Administration (FDA). VAERS is a post-marketing safety
surveillance program, collecting information about adverse events (possible side
effects) that occur after the administration of US licensed vaccines. Reports are
welcome from all concerned individuals and organizations.

Information identifying the person who received the vaccine will not be made
available to the public. You and/or your health care provider may be contacted
for follow-up information after your initial report is received.

Information supplied in this on-line form will be securely transmitted to

VAERS. Want to know how we securely transmit the confidential information that
you put on the form? Click here.

Before You Begin

Please review the on-line help for data entry before proceeding. To enter data
on-line, click

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Please use Netscape version 6.0 or higher. Download the latest version of
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To Enter Data Offline

You may obtain more information about the VAERS Program and download
printable copies of the VAERS form from the following Internet Sites:

1. The VAERS Web site at Download a copy of the

VAERS form (PDF 23K).

2. The Food and Drug Administration's Web site at

3. The Centers for Disease Control and Prevention Web site at

Submissions by mail may be sent to:

Vaccine Adverse Event Reporting System
P.O. Box 1100
Rockville, MD 20849-1100

A copy of the VAERS reporting form and instructions for how to submit it can be
obtained by calling toll-free 1-800-822-7967 or by toll-free fax at 1-877-721-0366.
You may also submit requests to VAERS via e-mail.

VAERS concentrates on collecting and analyzing the report data. You can obtain
general information on vaccines from the following sources:

If you have questions about vaccines and immunization schedules, call the
CDC National Immunization Hotline at 1-800-232-2522 (English) or 1-800-
232-0233 (Spanish), or visit the National immunization Program Web site.

To obtain more information on vaccine safety, visit CDC's vaccine safety Web
site for fact sheets and vaccine safety publications at:

The CDC Travelers Hotline at 1-877-FYI-TRIP is available around the clock

to provide immunization requirements and recommendations for international

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Centers for US
Disease Control Food and Drug
and Prevention Administration
VAERS is co-sponsored by the Centers for Disease Control and Prevention (CDC) and the
Food and Drug Administration (FDA), agencies of the U.S. Department of Health and Human Services.