Report Vaccine Injury to VAERS Government Database

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September 11, 2021

The Vaccine Adverse Events Reporting System is commonly known as VAERS. VAERS is a voluntary reporting system managed by the U. S. Department of Health and Human Services. VAERS relies on individuals such as patients, parents, healthcare providers or close family members to report adverse reactions to vaccines. You may submit a report to VAERS but “knowingly filing a false VAERS report is a violation of Federal law (18 U.S. Code § 1001) punishable by fine and imprisonment”.

The VAERS website states, “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”.

VITAL Information to complete a VAERS Report (shared by Vaers)

“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)”

Report An Adverse Reaction

There are two ways to report the information, 1) complete an online form or 2) download a “Writeable Form” to your computer, complete it on your computer and upload/return to VAERS.

1) Access/Complete the Online Vaers form here

2) Download Writeable form & access instructions to return to VAERS here

You may preview the contents of the form here but you must use the instructions on VAERS in this link or in the link immediately above to download the most current version of the form.

While the form may seem overwhelming, you are not required to answer all questions and may respond only to those you can answer truthfully. If you have questions or need assistance with reporting to VAERS, you may email info@VAERS.org or call 1-800-822-7967. Information that is required for reporting includes:

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)

All information identifying the vaccinated person or a person filing the report is kept confidential and is not available to the public. The person completing the report or the health care provider may be contacted for further information after filing a report.