Report of Adverse Event (Reaction) Following Immunization

AEFI Case Report Form

Health care providers are required by law to report Adverse Events Following Immunization (AEFIs) to monitor vaccine safety. Reports should be made using the British Columbia AEFI Case Report Form and sent to the local health unit. After filling and printing the form, send/fax it to your local health unit office:

Where to submit an AEFI report

Data from the form are to be entered into Panorama or PARIS by public health staff. Criteria for reporting and management of adverse events are found in the BC Communicable Disease Control Manual, Chapter 2: Immunization.

Part 5 - Adverse Events Following Immunization

AEFI Data Entry Guidelines 

The following resource is intended for BC health care providers completing the AEFI case report form or the Panorama AEFI form: User Guide for Completion and Submission of Adverse Events Following Immunization (AEFI) Reports.

Worksheet for Events Managed as Anaphylaxis Following Immunization

Anaphylaxis Worksheet

Events managed as anaphylaxis following immunization may be recorded on this BCCDC worksheet. This worksheet should be completed by the immunizing health care professional that observed and treated the client who experienced the anaphylactic episode. Management guidelines for these events are found in the BC Communicable Disease Control Manual, Chapter 2: Immunization.

Part 3 - Management of Anaphylaxis in a Non-Hospital Setting

After filling and printing the form, please submit the form to the appropriate Medical Health Officer (MHO) for review. Please also complete a Panorama report on this adverse event.

Reporting Form 

Confirmed Creutzfeldt-Jakob Disease (CJD) became reportable in BC in March 2007. To facilitate reporting when a case of CJD is confirmed by the National CJD surveillance system (CJD-SS) they will enter case details into the form and send to the attending neurologist. The neurologist will complete additional details and fax to public health to notify medical Health Officer. Please enter the case details into iPHIS and fax the form to Communicable Diseases and Immunization Service, BCCDC at 604-707-2516.

Enteric Provincial Surveillance Form with Panorama Guidance

Amebiasis

• Follow-up Form
  

AIDS

Case Report Form

AIDS is a reportable disease in British Columbia. AIDS reporting is accomplished by submitting a BC AIDS Case Report Form to the BC Centre for Disease Control, Division of STI/HIV Prevention and Control. If an AIDS-defining illness is diagnosed in an HIV positive patient, please download this form, complete and return by mail to:

The BC Centre for Disease Control 
Division of STI/HIV Prevention and Control 
HIV/AIDS Surveillance Nurse 
655 West 12th Avenue
Vancouver, B.C. V5Z 4R4

Gonorrhea and Chlamydia

• HLTH208 - Confidential Notification of Sexually Transmitted Infection Case Report Form (see below)
  

Gonorrhea and chlamydia are reportable diseases in British Columbia.

If gonorrhea and/or chlamydia are diagnosed within Vancouver Coastal Health Authority, or Fraser Health Authority, please download the following form (H208 – BCCDC), complete and return to: 

Hepatitis B: Acute HBV

• Acute HBV Case Report Form

As of January 1st, 2016, this form should be used by public health nurses for follow-up and surveillance of individuals identified with acute hepatitis B, in accordance with the follow-up practices of each Health Authority.      

Hepatitis C: Acute HCV

• Acute HCV Case Report Form

As of January 1, 2016, this form should be used by public health nurses for follow-up and surveillance of individuals identified with acute hepatitis C, in accordance with the follow-up practices of each Health Authority.

HIV

• HIV Case Report Form

HIV is a reportable disease in British Columbia. This surveillance form is intended for use by public health nurses responsible for the follow up, support and management of newly diagnosed HIV positive individuals in their Health Authority. Please download, complete and submit the form to:

HIV Surveillance Services

The BC Centre for Disease Control 

Clinical Prevention Services

Provincial STI/HIV Clinic

655 West 12th Avenue

Vancouver, B.C. V5Z 4R4

Fax: 604 707 5604

• HIV Partner or Contact Information Form

This form can be used by public health nurses as an adjunct to the HIV Case Report Form. It is intended to be used as a support tool or template to guide Partner or Contact notification and services for individuals who have been identified by an index case as being at risk of exposure to HIV during the trace-back period. This form is not to be submitted to BCCDC.

Screening Program Form (HLTH 939)

Instructions for HLTH 939