Adverse Event Reporting Form
A vaccine adverse event reporting form is used to report serious side effects related to immunizations. It is used by vaccine recipients and doctors and will help identify potential vaccine side effects. A vaccine adverse event reporting form is a document that is filled by a patient to report an adverse event related to an immunization, usually given for medical purposes to protect the individual against specific diseases, such as polio or chicken pox. This report will be used to assess the safety of a vaccine. An adverse event is any undesirable medical occurrence that is caused by a medication or a medical device. It can be a serious, unexpected occurrence that occurs during a person’s medical treatment or during a medical test or procedure. It can also be a side effect to a particular treatment or procedure. An adverse event can be also due to a pollutant or a food additive. The adverse event can be related to a factor that a patient was born with or it can be caused by a vaccine.
This template is fully customizable with not a single line of coding required at all! Simply clone the form then add more fields in order to collect more information. You can also add your logo and apply your own colors with advance design features. You can also integrate with other applications and automatically store this data in your other accounts. Make sure you are aware of all side effects of vaccination now.
These templates are suggested forms only. Before using this or any form as a contract or other legal document, please consult with an attorney to make sure it meets the legal needs or your situation. Do not use this form to send a legal request to Jotform.
These templates are suggested forms only. Before using this or any form as a contract or other legal document, please consult with an attorney to make sure it meets the legal needs or your situation. Do not use this form to send a legal request to Jotform.
