Privacy notice for reporting COVID-19 vaccine adverse reactions

The HPRA operates the national system for recording and reporting details of suspected adverse reactions occurring in Ireland. Please see full details of how personal data is processed in this area.

COVID-19 Vaccine Adverse Reaction Report

IN CONFIDENCE
Fields marked with an asterisk (*) are mandatory.

To move through the steps of the form please use the Next and Previous buttons that are at the bottom of the form.

  • Reporter Information
  • Patient Information
  • Vaccine Information
  • Suspected Reaction
  • Outcome
  • Photos & Files
  • Preview & Submit
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Reporter Information