ZFDA Pharmacovigilance Electronic Reporting System (PERS)
ZFDA PERS
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follow_up
ENG
staffBtn
modelConfirmTitle
×
modalDeleteMsg
modelConfirmTitle
×
confirmMessage
vaccinationDescription
1
Step 1
2
Step 2
3
Step 3
4
Step 4
5
Step 5
6
Step 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
*
BCG
POLIO
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