Blue card adverse reaction reporting form

Use this form to report suspected adverse reactions to vaccines and prescription, over-the-counter and complementary medicines.

Send completed Blue cards to the TGA:

• By mail to: Pharmacovigilance and Special Access Branch, Reply Paid 100, Woden ACT 2606
• By fax to: 02 6232 8392
• By email to: adr.reports@tga.gov.au

'Blue card' form

How to access a pdf document

This form can be filled in and saved to your computer using Adobe Reader version 7 or later or any version of Adobe Acrobat Standard or Professional. If you have an earlier version of Adobe Reader you can fill in the form on-screen and print it out but you will not be able to save the completed form