Zoetis Canada Pharmacovigilance Report

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Page 1 - Guidelines

Pour le accéder au formulaire en français cliquez ici

Zoetis values its customers. The intent of this form is to facilitate the reporting of suspected adverse events, including adverse reactions, lack of expected efficacy, product quality issues, or human exposure, involving Zoetis products.

  • Adverse Event is any observation or suspected reaction in an animal that is unfavourable and unintended and occurs after any use of a Zoetis product. The term Adverse Event includes events related to adverse reactions, suspected lack of efficacy, suspected product quality complaints, and suspected human exposure to a Zoetis product.
  • Adverse Reaction is a specific type of adverse event in which the administration of a Zoetis product may result in a harmful and/or unintended effect on an animal.
  • Lack of Efficacy is when a Zoetis product appears not to have the expected efficacy or does not meet the user’s expectations of efficacy.  
  • Product Quality Complaint is the deterioration or failure of a Zoetis product to meet approved specifications, including labeling and packaging defects.
  • Human Exposure describes any exposure of a human to a Zoetis product, which may involve a reaction or be asymptomatic. 

ℹ️ Please Note

  • Fields marked with an asterisk (*) are required.
  • Please have all test results and medical files handy for this patient so they can be transmitted easily to Zoetis if necessary.
  • A Zoetis Technical Services Representative will contact you to follow up once they have reviewed the submitted form.
  • All personal information is handled in accordance with Zoetis’ Privacy Policy

Page 2 - Primary Information



Select the date you are filling out this form

Please select all that apply. If ‘Other,’ provide details



First Name of the Reporter

Last Name of the Reporter

Select the option that best describes your role. If ‘Other,’ please specify.


Enter a valid email for follow-up, e.g. name@example.com

Enter a valid phone number for follow-up




Enter the full name of the main contact at the clinic or organization.

Enter the full name (first and last) of the veterinarian responsible for this case. If it’s the same as the reporter, you may re-enter your name.

If the primary contact is unavailable, enter the name of an alternate.

Please specify weekdays and hours



Enter the full name of the main contact at the clinic or organization.

Enter the full name (first and last) of the veterinarian responsible for this case. If it’s the same as the reporter, you may re-enter your name.

Page 3 - Animal/Pet Information











List any chronic illnesses, prior diagnoses, or ongoing treatments that may be relevant.

Page 4 - ADMINISTERED ZOETIS PRODUCT(S)


How many Zoetis Products were administrated?











has this product been administered before?











has this product been administered before?











has this product been administered before?











has this product been administered before?











has this product been administered before?

Page 5 - NON-ZOETIS PRODUCT(S)


Were any non-Zoetis products administered at the same time or shortly before/after the Zoetis product(s)?

Select how many other manufacturers’ products were given during the same period or within a few days before or after the Zoetis product(s).

























Page 6 - Event Description



How long after starting the Zoetis product did the adverse event begin

What was the duration of the adverse event?



Were any diagnostic tests performed on the patient?





Page 7 - Consent & Submission

ℹ️ Final Note (read carefully)


Please note: after clicking on Submit, you will be redirected to a review page displaying all your answers. You will have the opportunity to verify and, if necessary, edit your responses before making your final submission. At this stage, you may also print or save your form as PDF. This will be your last chance to review and preserve your information.




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