ObjectiveTo ascertain COVID‐19 vaccine uptake, reasons for hesitancy, and self‐reported flare in a large rheumatology practice‐based network.MethodsA tablet‐based survey was deployed by 108 rheumatology practices from 12/2021‐12/2022. Patients were asked about COVID‐19 vaccine status and why they might not receive a vaccine or booster. We used descriptive statistics to explore the differences between vaccination status and vaccine/booster hesitancy, comparing AIIRD to non‐AIIRD patients. We used multivariable logistic regression to examine the association between vaccine uptake and AIIRD status and self‐reported flare and AIIRD status. We reported adjusted odds ratios (aOR).ResultsOf the 61,158 patients, 89% reported at least one dose of vaccine; of the vaccinated, 68% reported at least one booster. Vaccinated patients were less likely to have AIIRDs (44% vs. 56%). A greater proportion of AIIRD patients were vaccine‐hesitant (14% vs. 10%) and booster‐hesitant (21% vs. 16%) compared to non‐AIIRD patients. Safety concerns (28%) and side effects (23%) were the main reasons for vaccine hesitancy, while lack of recommendation from the physician was the primary factor for booster hesitancy (23%). AIIRD patients did not have increased odds of self‐reported flare/worsening disease compared to non‐AIIRD patients (aOR: 0.99; 95% CI: 0.94, 1.05). Among the vaccine‐hesitant and booster‐hesitant, 12% and 39% later reported receiving a respective dose. AIIRD patients were 32% less likely to receive a vaccine (aOR: 0.68; 95% CI: 0.65, 0.72) versus non‐AIIRD patients.ConclusionSome vaccine and booster‐hesitant patients eventually receive a vaccine dose, and future interventions tailored to AIIRD patients may be fruitful.This article is protected by copyright. All rights reserved.image