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COVID-19 Vaccine Consent Form Patients LEGAL Last Name:PATIENT INFORMATION Patients LEGAL First Name: Phone Number:Age:Birthdate:Street Address:City:State:Zip Code:Assigned sex at birth:Race: (Select

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How to fill out vaers - report an

01

Go to the VAERS website

02

Click on the 'Report an Adverse Event' button

03

Fill out the required information including the patient's information, the vaccine received, and details of the adverse event

04

Submit the report

Who needs vaers - report an?

01

Healthcare providers

02

Vaccine manufacturers

03

Patients or caregivers who have experienced adverse events after vaccination

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What is vaers - report an?

VAERS stands for Vaccine Adverse Event Reporting System, it is a national system for monitoring the safety of vaccines.

Who is required to file vaers - report an?

Healthcare providers, vaccine manufacturers, and the public are required to file VAERS reports.

How to fill out vaers - report an?

VAERS reports can be filled out online on the VAERS website or by submitting a paper form.

What is the purpose of vaers - report an?

The purpose of VAERS is to monitor and gather information about adverse events or side effects that occur after vaccination.

What information must be reported on vaers - report an?

Information such as patient demographics, vaccine information, adverse event details, and healthcare provider contact information must be reported on VAERS.

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