Instructions: For more complete instructions and definitions, refer to the user guide 2025

1. Click ‘Get Form’ to open it in the editor.
2. Indicate whether this is an initial or follow-up report by checking the appropriate box on the top right corner of the first page.
3. Fill in the Unique Episode Number and Region Number if applicable; otherwise, leave them blank.
4. Complete patient identification details including last name, first name, address, and health number.
5. In section 4a, specify the Province/Territory where the vaccine was administered and provide the date of immunization in YYYY/MM/DD format.
6. For section 9, select all relevant AEFI details and record the time of onset and duration using appropriate units. Use section 10 for additional information as needed.

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