ZFDA Pharmacovigilance Electronic Reporting System (PERS)
ZFDA PERS
Home
follow_up
ENG
staffBtn
modelConfirmTitle
×
modalDeleteMsg
modelConfirmTitle
×
confirmMessage
patientDescription
1
Step 1
2
Step 2
3
Step 3
4
Step 4
5
Step 5
6
Step 6
7
Step 7
reporterHeading
fullName
*
email (optional)
phone
*
island
*
selectIsland
Unguja
Pemba
region
*
selectRegion
district
*
selectDistrict
ward
*
street
*
nextBtn
patientHeading
reporterType
*
--- selectReporterType ---
communityWork
careTaker
mother
patient
relative
other
fullName
*
dob (optional)
dobType (optional)
dobTypeSelect
hours
days
months
years
gender
*
--- chooseGender ---
male
female
island
*
selectIsland
Unguja
Pemba
region
*
selectRegion
district
*
selectDistrict
ward
*
street
*
# otherInformation
allergy (ifAny)
medicalHistory (ifAny)
previousBtn
nextBtn
suspectHeading
startDate
*
stopDate (optional)
latency
*
duration
previousBtn
nextBtn
medicineHeading
medicineType
*
medicineTypePlaceholder
Medicine
cosmetic
herbalMedicine
herbalCosmetic
medicalDevice
medicine
*
Amoxil, Trimox, Wymox, Novamox, Moxikind, Augmentin, Flemoxin
Bayer, Ecotrin, Bufferin, Anacin, Aspro, Disprin, Loprin
Advil, Motrin, Nurofen, Brufen, Ibupain, Ibugesic, Combiflam
Panadol
Panadol, Tylenol, Calpol, Fevadol, Panadeine, Panamax, Febrilex
source
*
hospital
pharmacy
supermarket
family
otc
frequency
*
--- selectFrequency ---
once
twice
three
four
asRequired
route
*
swallow
insert
injection
applied
drip
dose (optional)
startDate
*
stopDate (optional)
reason
*
saveBtn
#
name
type
source
dose
frequency
route
startDate
reason
noContent
previousBtn
nextBtn
herbalHeading
if_used_herbal
no
yes
previousBtn
nextBtn
extraHeading
uploadDocument
documentSample
uploadBtn
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