DescriptionVaccinations are routine procedures in pediatric offices, however studies have shown that most primary care settings offer little in the way of pain and anxiety management for the procedure. This lack of intervention combined with significant portions of the population suffering from needle fear and anxiety leads to vaccine hesitancy, delay, and refusal. One way to help this issue is the use of VR. This technology has been used to decrease pain and anxiety in adolescent patients during dressing changes, venipuncture, and vaccination for over 18 years. The costs of the technology have also decreased to make VR an affordable tool for primary care offices for use during vaccinations to help patients who have needle fear and anxiety. This project studied the affect VR has on the perceived pain of vaccination and the situational anxiety patients experience in a primary care office. A total of 104 subjects took part in the study, 52 using the VR during vaccination and 52 only experiencing standard office procedure. Analysis found that anxiety significantly decreased from 3.98 to 2.04 on numeric scales from 0-10 in subjects using the VR, U=1057, p=0.000077. Perceived pain levels also decreased from 3.06 to 2.31 on numeric scales from 0-10, U=750.5, p=0.052. Regression analysis taking into account higher baseline anxiety, number of shots, and higher frequency of more painful shots in the VR group showed that the use of the VR did lead to a significant reduction in pain, ?=-1.12, t(103)= -3.85, p=0.0002. These data show that the VR is an effective tool for vaccine pain and anxiety management, and primary care offices should be encouraged to implement the VR in their practices.