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ADVICE ABOUT REPORTING

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:

reaction

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)

Where to report:

Please return the completed form to the nearest

Adverse drug reaction Monitoring Centre (AMC)

or to

National Coordinating Centre

A list of nationwide AMCs is available at:

http

://cdsco.nic.in/pharmacovigilance.htm

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 managed by

WHO Uppsala Monitoring Center in Sweden.

The reports are periodically reviewed by the National

Coordinating Centre (PvPI). The information generated on

the basis of these reports helps in continuous assessment

of the benefit-risk ratio of medicines.

The information is submitted to the Steering

Committee of PvPI constituted by the Ministry of Health

and Family Welfare. The Committee is entrusted with the

responsibility to review the data and suggest any

interventions that may be required.

Suspected Adverse Drug

Reaction

Reporting Form

For VOLUNTARY reporting

of suspected adverse drug reactions by

health care professionals

Central Drugs Standard Control Organization

Directorate General of Health Services,

Ministry of Health & Family Welfare, Government of India

FDA Bhawan, ITO Kotla Road, New Delhi 110002

www .cdsco.nic.in

Pharmacovigilance

Programme

of

India

for

Assuring Drug

Safety

Confidentiality:

protected to the fullest extent. Programme staff is not ex- pected to

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

.

Pharmacovigilance Programme of India

(PvPI)

National Coordinating Centre

,

Indian Pharmacopoeia Commission

Ministry of Health & Family

Welfare,

Govt. of India

Sector-23, Raj Nagar, Ghaziabad-201 002.Tel.:0120-

2783400, 2783401, 2783392, FAX: 0120-2783311

E.mail:

ipcla b@vsnl.net

189