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VACCINE ADMINISTRATION CONSENT FORM SE C TI ON 1 IN FOR M A T I ON AB OF T The PE R SON RE CE I VI NG The VA CC IN E Name: Date of Birth: / / Phone: () Address: City:, TX Zip Code: Insurance Carrier
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What is v a c c?
VACC stands for Vaccine Adverse Event Reporting System.
Who is required to file v a c c?
Healthcare professionals, vaccine manufacturers, and individuals are required to file VACC reports.
How to fill out v a c c?
VACC reports can be filled out online through the VAERS website or by submitting a paper form.
What is the purpose of v a c c?
The purpose of VACC is to monitor and analyze adverse events following vaccination.
What information must be reported on v a c c?
Information such as the type of vaccine administered, the date of vaccination, the symptoms experienced, and any relevant medical history must be reported on VACC.
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