Report of Suspected Adverse Reaction due to Health Products Marketed in Canada (Vaccines excluded)

There are multiple ways to report an adverse reaction to Health Canada:

• Complete and submit your report on-line;
• Download and print a paper copy of the reporting form below to submit a report by mail or fax;
• Report an adverse reaction by phoning one of the Regional Adverse Reaction Monitoring Offices (1-866-234-2345).

The form below is fillable on your computer using Adobe Acrobat. Saving can only be done using the full version of Acrobat or Adobe Approval, not with the free Acrobat Reader. Alternatively, the form may be printed, filled manually, and faxed or mailed to the Canadian Adverse Drug Reaction Monitoring Program (see form for contact information). For more information on fillable forms.

This document is available in PDF format
Filename: ar-ei_form_e.pdf
Contact: CADRMP
Pages: 2
Size: 523 K,
Date of Original: 1998-12-01
Updated: 2006-04-25
Date Modified: 2006-04-07

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Software for using fillable forms

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• Adobe Acrobat Reader version 4.05 or higher
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Completing fillable forms

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Moving within a form

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Fields with a limited number of characters

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Specific fields

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Submitting forms that you've filled out

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Saving fillable forms

Trouble Shooting

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