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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.

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Important:

The HPRA cannot offer medical advice to individual patients. If you have any concerns about any symptoms you are experiencing, or have any queries about suitability for further vaccination, please contact a healthcare professional involved in your care.

Reporter Information
Patient Information
Vaccine Information
Suspected Reaction
Outcome
Photos & Files
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Reporter Information

Title: *

First Name: *

Surname: *

Organisation:

Department:

Address 1: *

Address 2:

Address 3:

City:

County:

Country:

Telephone:

Mobile:

Email: *

Confirm Email: *

Reporter Type:

Other (if not provided above)

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