Objective To understand the safety following immunization in people aged ≥65 years in Hebei province and to provide a basis for formulating vaccination service policies for the elderly in this province.

Methods We obtained the individual case data of adverse events following immunization (AEFIs) and vaccination data of people aged ≥ 65 years in Hebei province during 2020–2024 from the China Information System for Disease Control and Prevention and the Hebei Provincial Immunization Program Information Management System, respectively. We employed the descriptive epidemiological method to analyze the reported incidence rate and occurrence characteristics of AEFIs among people aged ≥ 65 years in Hebei province.

Results A total of 219 AEFIs were reported among people aged ≥65 years in Hebei province from 2020 to 2024, with an average annual reported incidence rate of 4.22 per 100 000. The incidence per 100 000 was 4.01 for common adverse reactions (208 cases, 94.98%) and 0.15 for rare adverse reactions (8 cases, 3.65%). The incidence rates of serious and non-serious AEFIs were 0.08 per 100 000 (4 cases, 1.83%) and 4.15 per 100 000 (215 cases, 98.17%), respectively. The main symptoms of common adverse reactions were fever, local redness and swelling, and local scleroma, with reported incidence rates of 1.52 per 100 000, 2.26 per 100 000, and 1.10 per 100 000, respectively. The main symptom of rare adverse events was allergic rash, with a reported incidence rate of 0.04 per 100 000.

Conclusions Immunization is safe among people aged ≥ 65 years in Hebei province, with mainly common adverse reactions being dominant and low incidence of rare adverse reactions.