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Appendix E Vaccine Adverse Event Reporting System (VAERS)
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Sex 6. Date form completed l mm dd yy I mm dd yy Lye Describe adverse events(s)
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treating a patient for a suspected adverse event should notify the VA and provide the information about the adverse event to allow the VA to complete the form to meet the VA's legal responsibility. These data will be used to increase understanding of adverse events following vaccination and will become part of CDC Privacy Act System 09-20-0136, "Epidemiologic Studies and Surveillance of Disease Problems".
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