In the USA you would use this form to report a vaccine injury. I would suggest that this form be reviewed prior to vaccination so that you have the information already available rather than having to look it up after the fact. If it were me, I would take the form to the medical appointment and I would go over every bit of information prior to an appointment with the doctor or medical professional administering the vaccine.

Here is the suggested checklist on the VAERS reporting website:

(VAERS will still accept a report even if you cannot provide all this information)

Information about the PATIENT who received the vaccine

• Name, address, phone number and email address
• Date of birth
• Sex (male or female)
• Date and time of vaccination
• Date and time the adverse event (health problem) started
• Age at vaccination
• Whether the patient was pregnant at the time of vaccination and the due date (for females only, if applicable)
• Prescriptions, over-the-counter medications, dietary supplements and herbal remedies
  being taken
• Allergies to medications, food, or other products
• Other illnesses at the time of vaccination (and up to one month prior) o Chronic or long-standing health conditions
• Information about the person completing or submitting the VAERS form
• Name, address, phone number and email address
• Relation to the patient (for example: healthcare professional, parent, caregiver, etc.)
• Information about the healthcare professional
• Name and phone number for the best doctor or healthcare professional to contact to get more information about the patient and the adverse event
• Information about the facility (or place) where the vaccine was given
• Facility/clinic name, fax number, address and phone number
• Facility type (for example: doctor’s office or hospital, pharmacy or drug store, workplace clinic, etc.)
• Information about which vaccines were given and what happened to the patient
• Vaccine type and brand name, manufacturer, and lot number
• How the vaccine was given (route of administration, body site where given, and dose number if the vaccine was part of a series)
• Description of the adverse event, including medical treatment and diagnosis
• Results of medical tests and laboratory tests
• Outcome of the adverse event (for example: doctor office visit, emergency room visit, hospitalization, etc.)
• Whether the patient has recovered from the adverse event
• Additional information
• Any other vaccines received by the patient within a month prior to the current vaccine(s) (include vaccine type and brand name, manufacturer, lot number, and how the vaccine was given)
• Adverse event(s) after previous vaccinations
• Patient’s race and ethnicity

In Canada, adverse vaccine events are reported to the Government of Canada. The Canadian Adverse Events Following Immunization Surveillance System (CAEFISS) is a federal, provincial and territorial public health post-market vaccine safety monitoring system. There is no compensation program as there is in the USA.

“Canada is the only G7 nation without a national vaccine injury compensation program. Neither Federal nor Provincial governments (except Quebec) have duty of care if you are injured by a vaccine. You are on your own.”

- Vaccine Choice Canada

This is the form that must be filled in to report an adverse vaccine event in Canada. Again, I would suggest you go over the form prior to your appointment with the doctor or medical personnel giving the vaccine and then go over the form with the medical professional as part of the appointment.