Weekly Vaccine Request Form
Providers must make a new request each week in order to receive vaccine. MSDH will do its best to accommodate each request in full.
Letters of authorization, facts sheets and resources for providers and recipients.
If your facility plans to administer COVID-19 vaccine, you must enroll as a COVID-19 provider.
For a healthcare personnel or healthcare facility to receive and administer vaccine priority groups, including healthcare staff, you must be enrolled as a COVID-19 vaccine provider.
Individual healthcare providers and personnel do not have to be enrolled as COVID-19 vaccine providers to be vaccinated against COVID-19.
Planning and Training
Reporting Adverse Reactions (VAERS)
The preferred way to submit an adverse reaction report to the CDC's Vaccine Adverse Event Reporting System (VAERS) is with their online form.
- Download a PDF form to submit
This writeable PDF form can be downloaded and completed electronically on your own time.
- Submit a completed PDF form
Submit a writeable PDF that you have completed offline.