ZFDA Pharmacovigilance Electronic Reporting System (PERS)
ZFDA PERS
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follow_up
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staffBtn
modelConfirmTitle
×
modalDeleteMsg
modelConfirmTitle
×
confirmMessage
Message Confirm
×
confirmMessage
proDescription
1
2
3
4
5
6
7
reporterHeading
fullName
*
email
*
phone
*
island
*
selectIsland
Unguja
Pemba
region
*
selectRegion
district
*
selectDistrict
ward
*
street
*
# facilityHeading
island
*
selectIsland
Unguja
Pemba
nextBtn
patientHeading
fullName
*
dob (optional)
dobType (optional)
dobTypeSelect
hours
days
months
years
gender
*
chooseGender
male
female
weight (optional)
height (optional)
island
*
selectIsland
Unguja
Pemba
region
*
selectRegion
district
*
selectDistrict
ward
*
street
*
# otherInformation
allergy (ifAny)
medicalHistory (ifAny)
previousBtn
nextBtn
suspectHeading
startDate
*
stopDate (optional)
latency
*
duration
Reaction Type
*
reactionPlaceholder
Immediate
Delayed
previousBtn
nextBtn
medicineHeading
medicineType
*
Medicine
cosmetic
herbalMedicine
herbalCosmetic
medicalDevice
medicine
*
batch (optional)
expire (optional)
source
*
hospital
pharmacy
supermarket
family
otc
dose (optional)
frequency
*
--- selectFrequency ---
once
twice
three
four
asRequired
route
*
swallow
insert
injection
applied
drip
startDate
*
stopDate (optional)
reason
*
saveBtn
#
name
batch
expire
source
dose
frequency
route
startDate
reason
noContent
previousBtn
nextBtn
herbalHeading
if_herbal
no
yes
previousBtn
nextBtn
LaboratoryHeading
startDate
laboratoryTest
#
test
startDate
complainType
creator
noContent
previousBtn
nextBtn
outcomeHeading
isReduce
no
yes
notUnknown
isReaper
no
yes
notApplicable
isSerious
no
yes
isTreated
no
yes
outcome:
status
*
---selectStatus---
recover
sequel
notRecover
unknown
died
previousBtn
submitBtn