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Adverse Event Reporting
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TGA identifier:
AU-TGA-0000782046
Your case identifier:
0000782046
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Step 1
Reporter details
Step 2
Patient details
Step 3
Vaccine details
Step 4
Medicine details
Step 5
List reactions
Step 6
Reaction details
Step 7
Summary report
Reporter details
We ask for contact details so that we can send you confirmation that we have received your report. We may also need to contact you for more information about your report.
Your case identifier
*
Are you a health professional?
*
Are you a health professional?
Pharmaceutical Company
Are you a health professional?
Regulatory Authority
Are you a health professional?
Health Professional
Are you a health professional?
Regional Pharmacovigilance Centre
Are you a health professional?
WHO Collaborating centres for international drug monitoring
Are you a health professional?
Other (e.g. distributor or other organisation)
Are you a health professional?
Patient/Consumer
Profession
*
Aboriginal and Torres Strait Islander Health Practitioner
Chinese Medicine Practitioner
Chiropractor
Dental Practitioner
Dietitian
Herbalist
Homoeopath
Medical Practitioner (General Practitioner)
Medical Practitioner (Other)
Medical Practitioner (Specialist)
Medical Radiation Practitioner
Midwife
Naturopath
Nurse
Nutritionist
Occupational Therapist
Optometrist
Osteopath
Other Healthcare professional
Pharmacist
Physiotherapist
Podiatrist
Psychologist
Unknown
Business name
*
*
Business type
*
Aged care facility
Clinic/practice
Community health centre
Community pharmacy
Coroners court
Hospice
Hospital
Other
State and territory health department
Unknown
Title
*
First name
*
*
Last name
*
*
Email
*
*
(Preferred)
Telephone
*
