ZFDA Pharmacovigilance Electronic Reporting System (PERS)
ZFDA PERS
Home
follow_up
ENG
staffBtn
modelConfirmTitle
×
modalDeleteMsg
modelConfirmTitle
×
confirmMessage
vaccinationDescription
1
2
3
4
5
6
reporterHeading
fullName
*
email (optional)
phone
*
island
*
selectIsland
Unguja
Pemba
region
*
selectRegion
district
*
selectDistrict
ward
*
street
*
# facilityHeading
island
*
selectIsland
Unguja
Pemba
nextBtn
patientHeading
fullName
*
phone
*
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
adverseHeading
startDate
*
stopDate (optional)
is_severeLocal
is_greater3days
is_beyondNearest
is_encephalopathy
is_toxicSock
is_thrombocytopenia
is_seizures
is_febrile
is_afebrile
is_abscessSepsis
is_anaphylaxis
is_fever
other
latencyVaccine
*
previousBtn
nextBtn
vaccineHeading
vaccine
*
Sinovac
Sinopharm
Moderna
Astra Zeneca
Pfizer
Cholera Vaccine
BCG
Oral Cholera Vaccine (OCV)
Inactivated Polio Vaccine (IPV)
Measles Rubella (MR)
Oral Polio Vaccine (OPV)
Tetanus Toxoid (TT)
Rotavirus Vaccine
Human papilloma Virus (HPV)
Pneumo Conj Vaccine
Pentavalent Vaccine
Johnson & Johnson
Diptheria and Tetanus
vaccineFor
*
dose (optional)
batchLot (optional)
vaccineDate
*
expire (optional)
saveBtn
#
name
batch
dose
startDate
expire
noContent
previousBtn
nextBtn
Diluent If Applicable
diluentName
batchLot
reconstitutionDate (optional)
expire (optional)
saveBtn
#
diluentName
batchLot
Reconstitution_date
expire
noContent
previousBtn
nextBtn
outcomeHeading
isSerious
no
yes
autopsy
no
yes
notUnknown
outcome:
status
*
---selectStatus---
recover
sequel
notRecover
Referred
unknown
died
remark (optional)
previousBtn
submitBtn