Adverse Drug Reaction Form
Forms / Adverse Drug Reaction Form
Reporting adverse events is a vital part of post-marketing surveillance of any new medication in determining its safety and efficacy.
Ophthalmologists have a duty of care to report suspected reactions to new medications, as well as outbreaks of conditions such as TASS.
The identification and tracking of cases is a critical means for information to be accurately collected and used in the interest of the vision health of all Canadians.
Physicians are invited to contribute case reports to the Canadian Ocular Adverse Drug Reactions Registry, a national registry managed by The Canadian Ophthalmological Society (COS) for collecting and recording proven or suspected ocular and systemic adverse reactions to ophthalmic medications.
The registry is sponsored jointly by COS and the Product-Related Disease Division of Health Canada’s Health Protection Branch.
Adverse drug reaction case reports should include the following details:
- age and gender of the patient
- suspected drug
- route and daily dose
- nature and course of the event
- other drugs taken at the time
- an opinion as to the cause and effect
Submit an Adverse Drug Reaction Report 
Dr. Paul Rafuse
COS Board Liaison, Pharmacology Affairs
Canadian Ophthalmological Society
110 – 2733 Lancaster Rd.
Ottawa, Ontario K1B 0A9
Fax: 613.729.7209
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