A vaccine adverse event reporting form should be completed whenever an adverse reaction to a vaccine occurs. The information submitted provides valuable information to the Centers for Disease Control and Prevention and may enhance the understanding of adverse reactions to vaccines.

For a larger version of this form, click the image to the left. (90K, requires Adobe Acrobat).

MANDATORY REPORTING FORM

MEDICATION & DEVICE
EXPERIENCE REPORT

The Food and Drug Administration (FDA) requires that all deaths and serious injuries related to a drug or medical device be reported using the MedWatch form shown below. This mandatory two-page form is designed for use by facilities, distributors, importers, applicants, and manufacturers.

For a larger version of this form, click the images to the left. (90K, requires Adobe Acrobat).

The voluntary form to the left is designed for use by healthcare professionals and consumers who wish to report adverse events and other problems with drugs, medical devices, special nutritional products, and other FDA-regulated items. Use of this form promotes rapid detection of problems.

For a larger version of this form, click the image to the left. (90K, requires Adobe Acrobat).