Reporting Form for Suspected Adverse Reactions

Personal information will be kept confidential.
All suspected reactions are to be reported with relevant details.

1. Patient / consumer identification (please complete or tick boxes below as appropriate)

2. Description of the suspected Adverse Reactions

3. Whether the patient is suffering with any chronic disorders?

6. Details of the drug suspected to cause ADR

Fill the above reporting form and submit
Send us filled form to the below mentioned address

Postal Address:
The Coordinator, National Pharmacovigilance Centre
All India Institute of Ayurveda, Sarita Vihar, New Delhi – 110076


Download the Reporting Form

You can fill the form digitally and send us via email
Print any of the downloaded form file and send us the manually filled form to our postal address

Upload Reporting Form

Upload your filled or scanned reporting form in .jpg, .pdf, .doc or .docx format only.