Free Pharmacovigilance Tool

ADR Report Generator

Fill out a Suspected Adverse Drug Reaction report in the official Pharmacy and Poisons Board (PPB) format and save it as a PDF. All data stays in your browser.

ADR details

Report
Institution
1. Patient information
2. Suspected adverse reaction
3. Medical history
4. Suspected medicine
6. Dechallenge / rechallenge
7. Lab investigations
8. Grading of the reaction / event
9. Other comment
10. Reporter details

Report preview

Fill the form and click Generate Report to render the PPB Suspected ADR Reporting Form here. Use Print / Save PDF to save it.

Important

This generator reproduces the layout of the PPB Suspected Adverse Drug Reaction Reporting Form (FOM001/MIP/PMS/SOP/001) as a drafting and printing aid. The official report should be submitted via the PPB Pharmacovigilance Electronic Reporting System (PvERS) or sent to the Pharmacy and Poisons Board.

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What is adverse drug reaction (ADR) reporting?

Adverse drug reaction reporting, also called pharmacovigilance reporting, is how the safety of medicines is monitored after they reach patients. Clinical trials test a medicine in a few thousand people under controlled conditions, so rare, delayed, or population-specific reactions often only surface once the product is in everyday use. Spontaneous reports from healthcare workers and patients are the main early-warning signal that regulators rely on.

In Kenya the Pharmacy and Poisons Board (PPB) runs the National Pharmacovigilance Centre and collects suspected ADR reports on the form reproduced by this tool. Reports can be submitted online through the PPB Pharmacovigilance Electronic Reporting System (PvERS) or on the printed Suspected ADR Reporting Form. The anonymised data is shared with the WHO global safety database, so a signal seen in Nairobi can contribute to action taken anywhere.

A good report does not need to prove that the medicine caused the harm. It needs enough detail for an assessor to evaluate the link: who the patient was, which medicine was taken and at what dose, what reaction occurred and when, whether it eased when the drug was stopped, and how serious it was. The fields in this generator follow the official form so nothing important is missed.

How to use this ADR report generator

1

Capture the patient and medicine details

Fill in the patient initials, age, weight, and the suspected medicine, including its generic (INN) name, brand, batch or lot number, dose, route, and the dates it was started and stopped. Batch numbers matter for quality-related signals.

2

Describe the reaction and its timeline

Record what happened, the date of onset, and the dechallenge and rechallenge response. Note any relevant medical history, allergies, and other medicines taken in the last three months.

3

Grade seriousness and causality

Use the grading section to mark severity, whether the reaction is serious, the seriousness criteria that apply, the action taken, and the outcome. This is the information assessors use for causality assessment.

4

Generate, save, and submit

Click Generate Report to render the official PPB form, then Print or Save PDF. Submit the report to the PPB through PvERS or to the National Pharmacovigilance Centre.

Frequently Asked Questions

About adverse drug reaction reporting and this tool

What is an adverse drug reaction (ADR)?+
The World Health Organization defines an adverse drug reaction (ADR) as a response to a medicine that is noxious and unintended, occurring at doses normally used in humans for prophylaxis, diagnosis, or therapy. It differs from an adverse event, which is any untoward medical occurrence that may not have a proven causal link to the medicine. Reporting suspected ADRs lets regulators monitor the safety of medicines once they are in real-world use.
Who can report an adverse drug reaction in Kenya?+
Any healthcare professional can report, including doctors, pharmacists, pharmaceutical technologists, nurses, and clinical officers, and patients or their carers are encouraged to report too. Marketing authorisation holders and Local Technical Representatives carry a legal duty to report suspected reactions for their products. The PPB encourages reporting even when you are not sure the medicine is to blame, summed up in the phrase you need not be certain, just be suspicious.
Which form does the PPB use for ADR reporting?+
The PPB uses the Suspected Adverse Drug Reaction Reporting Form, reference FOM001/MIP/PMS/SOP/001. It captures patient information, the suspected medicine, a description of the reaction, seriousness and grading, dechallenge and rechallenge, and the reporter's details. This tool reproduces that official layout so you can fill it in on screen and save a clean PDF.
What makes an adverse drug reaction serious?+
A reaction is classed as serious if it results in death, is life threatening, requires or prolongs hospitalisation, causes persistent or significant disability or incapacity, leads to a congenital anomaly or birth defect, or is otherwise medically important. Serious reactions usually need to be reported promptly. The grading section of the form lets you tick the criteria that apply.
What is causality assessment in pharmacovigilance?+
Causality assessment is the structured process of judging how likely it is that a medicine caused a reaction. The WHO-UMC system uses categories such as certain, probable, possible, unlikely, conditional or unclassified, and unassessable. Assessors weigh the timing of the reaction, the dechallenge and rechallenge response, plausible alternative causes, and what is already known about the medicine.
What are dechallenge and rechallenge?+
Dechallenge asks whether the reaction improved when the medicine was stopped or the dose was reduced. Rechallenge asks whether the reaction came back when the medicine was given again. A positive dechallenge followed by a positive rechallenge strengthens the case that the medicine caused the reaction, though deliberate rechallenge is often avoided because it can put the patient at risk.
Is this ADR report generator free and private?+
Yes. This ADR report generator is completely free and needs no account or sign-up. Everything you type stays in your browser and is never sent to our servers, so patient information remains confidential on your own device. When you are done you can print the form or save it as a PDF for your records.
How do I submit my completed ADR report to the PPB?+
This tool only drafts and prints the form. Submit the official report through the PPB Pharmacovigilance Electronic Reporting System (PvERS) online portal, or deliver or email the completed form to the Pharmacy and Poisons Board National Pharmacovigilance Centre. From there the data feeds into the WHO global safety database that pools reports from across the world.

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