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Vaccine Adverse Effects: An Overview

Sarah Coles, MD

American Family Physician. 2026;113(4):339-348.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Related Curbside Consultation, Vaccine Conversations: Meeting Patients Where They Are, is available

Published online March 16, 2026.

Vaccines are one of the most successful medical advances in modern times. Patients are increasingly questioning the necessity of immunizing themselves and their families, and family physicians should be aware of the risks and benefits of recommended immunizations to accurately counsel about adverse effects and address vaccine hesitancy. Vaccines are associated with local adverse reactions, such as pain and redness. Thimerosal is currently used only in multidose vials of influenza vaccine; exposure to thimerosal through vaccines is not associated with adverse neurologic outcomes. The measles-mumps-rubella vaccine is not associated with autism spectrum disorder. The respiratory syncytial virus vaccine does not increase the risk of stillbirth, infant death, birth defects, or growth restriction when administered during pregnancy. COVID-19 vaccine minimally increases the risk of myocarditis and pericarditis. Physicians should counsel patients and guide them to credible resources if patients are considering vaccine refusal. The Vaccine Adverse Event Reporting System and National Vaccine Injury Compensation Program track adverse events from vaccines; the National Vaccine Injury Compensation Program provides compensation for documented harms from vaccinations.

Vaccination is one of the most successful interventions in the past century to reduce morbidity and mortality worldwide. Since 1974, vaccination has averted 154 million deaths worldwide, including 146 million children younger than 5 years.1 In the United States between 1994 and 2023, routine childhood vaccination prevented approximately 508 million lifetime cases of illness, 32 million hospitalizations, and 1,129,000 deaths, saving an estimated $2.7 trillion in societal costs.2 Despite these data, vaccination rates are declining.3 In 2023–2024 in the United States, 3.3% of kindergartners had an exemption from at least one required vaccine.3 Approximately 7.3% of kindergartners did not have documentation of two measles-mumps-rubella (MMR) vaccine doses and were at risk for measles infection.3 Adult vaccination adherence is also less than optimal, with only 22.8% of adults receiving all age-based recommended vaccines in 2022.4

WHAT'S NEW ON THIS TOPIC

Vaccine Adverse Effects
The United States had the largest outbreak of measles in 2026 since measles was declared eliminated in 2000.
V-Safe is a newer vaccine safety program that monitors COVID-19 and respiratory syncytial virus vaccines.
Respiratory syncytial virus vaccination during pregnancy does not increase the risk of stillbirth, birth defects, growth restriction, or infant death.
Egg allergy is not a contraindication or precaution for any influenza vaccine, even when the vaccine is egg based.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments
Administration of acetaminophen following vaccination may lessen reactogenicity with minimal or no blunting of the immune response, particularly in booster doses.17 CObservational studies and limited, inconsistent randomized controlled clinical trials showing decreased symptoms and minimal or no blunting of antibody response
Physicians should review the excipients and media list for recommended vaccines to ensure patients with a history of anaphylaxis and severe allergies to these ingredients are not inadvertently exposed.19 CExpert opinion in the absence of clinical trials
No causal link has been found between MMR vaccination and ASD; MMR vaccine should be recommended routinely. MMR vaccine is associated with a small risk of febrile seizure.20 BMeta-analysis demonstrating no association between MMR vaccine and ASD and a small increased risk in febrile seizures with MMR vaccine
Influenza vaccine has not been associated with adverse outcomes during pregnancy. Influenza vaccine (IIV3, RIV3) is recommended during pregnancy or in those who may become pregnant; live attenuated influenza virus vaccines should not be used during pregnancy but can be used postpartum.32 CACIP guidelines on consistent results from case-control studies showing no increase in adverse outcomes during pregnancy
COVID-19 vaccine is associated with a small increased risk in myocarditis and pericarditis, although risk is significantly less than having COVID-19 infection and has better clinical outcomes.27,65,66,72 BCohort study of clinical outcomes, systematic review, and case reviews of the Vaccine Safety Datalink demonstrating a small increased risk in myocarditis and pericarditis

ACIP = Advisory Committee on Immunization Practices; ASD = autism spectrum disorder; MMR = measles-mumps-rubella.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SARAH COLES, MD, FAAFP, is a program director at the Colorado Plateau Center for Health Professions Family and Community Medicine Residency at North Country HealthCare and an associate professor of Family, Community, and Preventive Medicine at the University of Arizona College of Medicine – Phoenix. See Editor's Note.

Published online March 16, 2026.

Address correspondence to Sarah Coles, MD, FAAFP, at swhitley@arizona.edu.

Author disclosure: No relevant financial relationships.

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