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Vaccination is the primary public health tool for influenza control. Rapid assessment of the safety of any widely disseminated pandemic influenza vaccine is a public health priority. This study identifies practices, strengths, and weaknesses of vaccine-associated adverse event (AE) reporting to inform public health systems improvement.A survey was developed with local and state health agencies' input. After pre-testing, the survey was distributed online and via mail to a random sample of King County, WA, healthcare professionals, composed of 60 commercial vaccinator employees and school health nurses, 500 physicians, and 300 pharmacists.The response rate was 36%. Results indicate that if an AE was suspected, 17% of respondents would not know how to report it, with 61% of respondents citing unclear definitions of a reportable AE as a barrier and 18% of respondents unaware of whose responsibility it is to report an AE.Healthcare professionals who provide immunizations need additional information on their role in vaccine safety and AE reporting. Strengthening both passive and active reporting systems can enhance surveillance efforts during real-time events, such as mass immunization during a pandemic and other large-scale emergency countermeasure distribution programs. Copyright © 2011 John Wiley & Sons, Ltd.