Report adverse experiences with medications. Report serious adverse reactions. A reaction is serious when the patient outcome is

  • Death
  • Life-threatening (real risk of dying)
  • Hospitalization (initial or prolonged )
  • Disability (significant, persistent or permanent congenital anomaly)
  • Required intervention to prevent permanent impairment or damage

Report even if:

  • You're not certain the product caused adverse reaction
  • You don't have all the details, however, point nos. 1, 5, 7, 8, 11, 15, 16 & 18 (see reverse) are essentially required.

Who can report:

  • Any health care professional (Doctors including Dentists, Nurses and Pharmacists)

What happens to the submitted information:

  • Information provided in this form is handled in strict confidence. The causality assessment is carried out at Adverse Drug Reaction Monitoring Centres (AMCs) by using WHO-UMC scale. The analyzed forms are forwarded to the National Coordinating Centre through the ADR database. Finally the data is analyzed and forwarded to the Global Pharmacovigilance Database. We require you to send the report to us fully filled as specified by regulations. The reports received will be checked, acted upon and soon solution from us will be delivered.

Steps to send adverse event report:

Step 2

Fill This Form
Step 3

Attach and send it to

Confidentiality : The patient's identity is held in strict confidence and protected to the fullest extent. Programme staff is not ex- pected to and will not disclose the reporter's identity in response to a request from the public. Submission of a report does not constitute an admission that medical personnel or manufacturer or the product caused or contributed to the reaction.