CoronaVac COVID-19 Vaccine [Sinovac] Adverse Event Reporting Form

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The patient’s identity and the reporter's identity will be held in strict confidence by our Company and protected to the fullest extent of the law. The information collected in this form will be used to process and generate your Adverse Event Report or Individual Case Safety Report and submitted to the concerned Regulatory Authorities.

PRIVACY NOTICE: Through this form, the patient's personal information and the reporter's personal information will be collected. The Company will share the data with its third party data processor and with the parties under the DOH AO no. 2021-0005 dated 12 January 2021 [National Strategic Policy Framework for COVID-19 Vaccine Deployment and Immunization]. We value your rights as data subjects under the Data Privacy Act.

Please tick the box to proceed to the next section *

Yes, I have read and understood the Privacy Notice. I want to report the adverse event or adverse reaction

Are you (the reporter) also the patient who experienced the adverse event/s? *

Yes

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