All information collected in this form, identities of the reporter and patient, will remain confidential.
WHAT TO REPORT
An Adverse Drug Reaction (ADR) is defined as a reaction that is noxious and unintended, and occurs at doses normally used in
man for prophylaxis, diagnosis or treatment of a disease, or for modification of physiological function.
Report all suspected adverse experiences with medications,
especially those where the patient outcome is
- Life-threatening (real risk of dying)
- Hospitalization (initial or prolonged)
- Disability (significant, persistent or permanent)
- Congenital anomaly
- Required intervention to prevent permanent impairement or damage
Report even if:
- You are not certain if the drug caused the reaction
- You do not have all the details
WHO CAN REPORT
All healthcare professionals (clinicians, dentists, nurses, pharmacists, physiotherapists, community health
workers etc) are encouraged to report. Patients (or their next of kin) may also report.
WHAT HAPPENS TO THE SUBMITTED INFORMATION
All information submitted is handled in strict confidence. The Pharmacy and Poisons Board will assess causality and
statistical analysis on each form. Data will periodically be used to review and suggest any interventions that may
be required to the Ministry of Health. Data will also be submitted periodically to the Uppsala Monitoring Center -
the WHO Collaborating Center for International Drug Monitoring in Sweden
SUBMISSION OF INITIAL OR FOLLOW-UP REPORTS
It is important to tick the appropriate box on the top-right corner of the front page to indicate whether the report
is an initial (original) report or is a follow-up (subsequent) report.
It is very important that follow-up reports are identified and linked to the original report.
WHERE TO REPORT
After completing this form, please forward the same to your Pharmacy Department for onward submission,
or mail directly, to:
THE PHARMACY AND POISONS BOARD
P.O. Box 27663-00506 NAIROBI