Public Health Agency of Canada
www.publichealth.gc.ca
Adverse Events Following Immunization Reporting Form
For Vaccines
For drugs and other health products
See Also
Disclaimer: The HTML version of this form is a representation of the content only. Please download the PDF version. If you encounter problems or have questions regarding the PDF please contact the Public Health Agency of Canada at: caefi@phac-aspc.gc.ca
Report of Adverse Events Following Immunization (AEFI)
General Information
The Public Health Agency of Canada collects case reports on adverse events following immunization from provincial and territorial health departments, health care professionals and the pharmaceutical industry.
The data is stored in the Canadian Adverse Events Following Immunization (CAEFI) database and is used to signal adverse events that may require more in-depth investigation. The main function of the Canadian Adverse Events Following Immunization Surveillance System (CAEFISS) is to ensure the continued safety of vaccines on the Canadian market by monitoring adverse events following immunization with vaccines.
Adverse Events Following Immunization Reporting Form
How to Report
For health care professionals
If a patient experiences an adverse event following immunization, please complete the appropriate Adverse Events following Immunization (AEFI) Form and send it to your local Health Unit in your province/territory.
For the General Public
Should you experience an adverse event following immunization, please ask your doctor, nurse, or pharmacist to complete the Adverse Events following Immunization (AEFI) Form.
If you have any questions or have difficulties contacting your local health unit, please contact Vaccine Safety Section at Public Health Agency of Canada (Tel: 613-954-5590, 1-866-844-0018; Fax 613-954-9874; 1-866-844-5931)
Reporting adverse reactions to drugs and other health products
To report adverse reactions to drugs and other health products visit:
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