Content on this page was developed during the 2009-2010 H1N1 pandemic and has not been updated.
- The H1N1 virus that caused that pandemic is now a regular human flu virus and continues to circulate seasonally worldwide.
- The English language content on this website is being archived for historic and reference purposes only.
- For current, updated information on seasonal flu, including information about H1N1, see the CDC Seasonal Flu website.
Template Letter for Healthcare Providers about the Vaccine Adverse Event Reporting System (VAERS)
October 12, 2009 2:00 PM ET
CDC created the following template for you to use as an email or standard mail letter to encourage healthcare providers in your area to report adverse events following vaccination to the Vaccine Adverse Event Reporting System (VAERS). You may use the letter in part or in full.
[Insert State or Local Health Department Logo]
[Insert State or Local Health Department Address]
Dear Healthcare Provider:
As a healthcare provider, you can help monitor the safety of vaccines by promptly and accurately reporting any clinically significant adverse event that occurs following vaccination to the Vaccine Adverse Event Reporting System (VAERS). Clinically significant adverse events are those events that are of concern to you or your vaccinated patients or their caregivers. Anyone can report to VAERS but vaccinated patients or their caregivers are encouraged to seek the help of their health care provider in filling out a VAERS form. Please report clinically significant adverse events after vaccination, whether or not the vaccine was administered in your practice, and even if you are not sure if the vaccine caused the adverse event.
VAERS is a U.S. vaccine safety surveillance system, co-managed by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). VAERS is the front-line monitoring system for collecting and analyzing voluntary reports of adverse events following vaccination. CDC and FDA analyze VAERS reports to identify potential vaccine safety concerns that may need further study or public health action.
There are three ways to report to VAERS:
1) Submit online via a secure website
2) Fax a completed VAERS form to 877-721-0366, or
3) Mail a completed VAERS form to VAERS, P.O. Box 1100, Rockville, MD 20849-1100.
A VAERS form may be downloaded from the VAERS website. Alternatively, you may request a VAERS form by sending an email, by calling toll-free 800-822-7967, or by sending a faxed request to 877-721-0366. For additional information on VAERS or vaccine safety, visit the VAERS website or call 800-822-7967.
When submitting a report to VAERS, please include as much information requested on the form as possible to assist VAERS staff with analysis and follow-up of the adverse event. For example, please include information about vaccination location, date, vaccine type, lot number and dose. The form also includes a space to provide contact information for the person reporting the adverse event.
Influenza vaccination record cards will be given to people who receive 2009 influenza A (H1N1) monovalent vaccine. The information on this card may be helpful in completing a VAERS report for an adverse event that occurred after 2009 H1N1. It also can include information on seasonal influenza vaccines.
By reporting vaccine adverse events to VAERS, the public health system will continue to be able to rapidly detect potential risks for serious or new adverse events after vaccination. This knowledge facilitates improvements in the safety of vaccines. Thank you in advance for your participation. Together we can ensure that vaccination continues to be as safe as possible.
[Insert State or Local Health Department Official]
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