PSO Healthcare Practitioner Medication and Vaccine Event Report

Use the form below to report a medication or vaccine related event to ECRI and the ISMP PSO

Please answer the questions as completely and accurately as possible. Your answers will help us to better understand the type of events that are happening, where and why they are happening, and how to help those people being affected. We will contact you if there are any questions that we have when reviewing the report.


Please provide as much information as possible.

If this is a medication or vaccine related issue, please give us as much detail about the event and associated process breakdowns as possible.

If this problem involves a specific medication or vaccine, please include the names and manufacturers of each product involved. We ask that you also include other pertinent information, including dosage form (e.g., capsule, tablet, injection), concentration or strength, and dose, that will help us to more fully analyze the issue and advocate for change.

Please tell use the reasons (e.g., causes, contributing factors) why this event happened.
Please describe the strategies and/or process changes you put in place to prevent possible future events.