Acute allergic events (including anaphylaxis)
                 
following Immunisation to COVID-19

Use this online form to report suspected allergic reactions (including anaphylaxis) following immunisation to COVID-19.

This form does not replace the need to report suspected adverse events following immunisation to COVID-19 via the Yellow Card scheme.

If you have already reported using the Yellow Card system and have received a link to this proforma to provide additional information, then please proceed below.

If you have not yet reported to the MHRA, then complete this proforma. On the final screen, a summary of your responses will be displayed which you can copy into the Yellow Card form online. You will then be given a MHRA report number which you willl need to enter before final submission.

This system is a collaboration between Public Health England, NHSE and MHRA. PHE is the data owner and controller, and is authorised under Regulation 3 and 7 of the Health Service (Control of Patient Information) Regulations 2002 to collect the data (including personal identifiables [PII]) requested below.

REPORTER DETAILS

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SERVICE PROVIDER

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