Get Aefi Reporting Form

The AEFI Reporting Form is essential for documenting adverse events following immunization. This guide will provide you with step-by-step instructions to fill out the form online, ensuring a smooth reporting process.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Fill in the client information section. Provide the first name, last name, personal health number (PHN), postal code, phone number, address, province, date of birth, and gender. Make sure all details are accurate.
3. In the patient’s physician or primary care provider section, enter the physician's first name, last name, address, phone number, and fax number.
4. Complete the reporter information section by specifying the setting (e.g., physician office, public health, hospital), providing the reporter's name, phone number, address, and fax number. Additionally, include the date reported and the reporter’s signature.
5. In the immunization data section, provide details about the immunizing agent, including the trade name, manufacturer, lot number, dosage, route, and site of administration.
6. Fill out the section on information at the time of immunization and AEFI onset. Include the province/territory of immunization, date vaccine administered, age at onset, and health care provider information. Indicate if an AEFI occurred after prior doses or if an incorrect immunization was given.
7. Complete the AEFI details section by selecting all relevant signs and symptoms that apply to the adverse event. Provide onset and duration of symptoms as required.
8. In the impact of AEFI section, choose the highest impact of the AEFI and the outcome at the time of reporting. Indicate the highest level of care received.
9. Provide any public health recommendations based on further information and enter personal comments if necessary.
10. Include supplementary information where needed and append additional pages if required. Review all sections for completeness.
11. Once you have filled out all necessary sections, you can save changes, download, print, or share the form as needed.

Complete your AEFI Reporting Form online today to ensure timely and accurate reporting.