Guideline on good pharmacovigilance practices (GVP)

1 See websites for contact details European Medicines Agency Heads of Medicines Agencies The European Medicines Agency is an agency of the European Union European Medicines Agency and Heads of Medicines Agencies, 2017. Reproduction is authorised provided the source is acknowledged. 28 July 2017 EMA/873138/2011 Rev 2* Guideline on good pharmacovigilance practices (GVP) Module VI Collection, management and submission of reports of suspected adverse reactions to medicinal products (Rev 2) Date for coming into effect of first version 2 July 2012 Date for coming into effect of Revision 1 16 September 2014 Draft Revision 2* finalised by the Agency in collaboration with Member States 15 July 2016 Draft Revision 2 agreed by the European Risk Management Facilitation Group (ERMS FG) 26 July 2016 Draft Revision 2 adopted by Executive Director 4 August 2016 Release for public consultation 8 August 2016 End of consultation (deadline for comments)

2 14 October 2016 Revised draft Revision 2 finalised by the Agency in collaboration with Member States 6 July 2017 Revised draft Revision 2 agreed by the EU Network pharmacovigilance Oversight Group (EU-POG) 25 July 2017 Revised draft Revision 2 adopted by Executive Director as final 28 July 2017 Date for coming into effect of Revision 2* 22 November 2017 * Note: Revision 2 contains the following: - Updated guidance on ICSRs submission, follow-up, duplicate detection and data quality management, taking into account the implementation of the new EudraVigilance system, and of the simplified submission of ICSRs in the EU in line with the provisions provided in Article 24 of Regulation (EC) No 726/2004 and Article 107 and 107a of Directive 2001/83/EC; - Updated guidance on the validation of ICSRs based on patients and reporters identifiability; - Updated guidance on the management of ICSRs described in the medical literature; - Updated guidance on the collection of information on patient s age.

3 - Updated guidance on the management of suspected adverse reactions reported through medical enquiry and product information services; - New guidance on the electronic submission modalities of ICSRs under the new ICH-E2B(R3) format; - New guidance on the management of individual reports of off-label use, based on the Reflection Paper on Collecting and Reporting Information on Off-label Use in pharmacovigilance (EMA/293194/2016), published for public consultation in 2016; - New guidance on the management of reports from post-authorisation efficacy studies; - Transfer of the guidance on emerging safety issue to GVP Module IX; - Editorial amendments to align the format with other GVP Modules.

4 Guideline on good pharmacovigilance practices (GVP) Module VI (Rev 2) EMA/873138/2011 Rev 2 Page 2/144 TABLE OF CONTENTS Introduction .. 6 Terminology .. 6 Adverse reaction, causality .. 6 Overdose, off-label use, misuse, abuse, occupational exposure, medication error, falsified medicinal product .. 7 Active substance, excipient, medicinal product .. 7 Primary source, healthcare professional, consumer .. 8 Medical confirmation .. 8 Seriousness .. 9 Individual case safety report (ICSR) .. 9 nullFlavors .. 9 Structures and 11 Collection of individual safety 11 Unsolicited reports .. 11 Spontaneous reports .. 11 Literature reports .. 12 Reports from non-medical sources.

5 13 Information on suspected adverse reactions from the internet or digital media . 13 Solicited reports .. 13 Validation of reports .. 14 Follow-up of reports .. 16 Data management .. 17 Quality management .. 18 Special situations .. 18 Use of a medicinal product during pregnancy or breastfeeding .. 18 Use of a medicinal product in a paediatric or elderly population .. 20 Reports of overdose, abuse, misuse, medication error or occupational exposure . 20 Lack of therapeutic efficacy .. 20 Submission of individual case safety reports (ICSRs) .. 21 Submission time frames of ICSRs .. 22 Report nullification .. 22 Report amendment .. 22 Modalities for submission of individual case safety reports (ICSRs).

6 22 Operation of the EU network .. 24 Management of individual safety reports for clinical trials, post-authorisation studies, compassionate use and named patient use in the EU .. 25 Management of individual safety reports for clinical trials .. 26 Management of individual safety reports for non-interventional post-authorisation studies, compassionate use and named patient 27 Non-interventional post-authorisation studies .. 28 Non-interventional post-authorisation studies with a design based on primary data collection .. 29 Non-interventional post-authorisation studies with a design based on secondary use of data .. 30 Compassionate use and named patient use .. 30 Guideline on good pharmacovigilance practices (GVP) Module VI (Rev 2) EMA/873138/2011 Rev 2 Page 3/144 Collection of individual safety reports.

7 31 Responsibilities of Member 31 Responsibilities of the marketing authorisation holder in the EU .. 33 Spontaneous reports .. 34 Solicited reports .. 34 Case reports published in the medical literature .. 35 Monitoring of the medical literature by the European Medicines Agency .. 35 Exclusion criteria for the submission of ICSRs published in the medical literature .. 35 Suspected adverse reactions related to quality defect or falsified medicinal products .. 36 Suspected transmission via a medicinal product of an infectious agent .. 36 Emerging safety issues .. 37 Period between the submission of the marketing authorisation application and the granting of the marketing authorisation.

8 38 Period after suspension, revocation or withdrawal of marketing authorisation .. 38 Period during a public health emergency .. 38 Reports from class action lawsuits .. 38 Reports from patient support programmes and market research programmes 39 Reporting of off-label use .. 39 Submission time frames of ICSRs in EU .. 40 Submission modalities of ICSRs in EU .. 41 Collaboration with the World Health Organization and the European Monitoring Centre for Drugs and Drug Addiction .. 42 Electronic exchange of safety information in the EU .. 43 Applicable guidelines, definitions, international formats, standards and terminologies .. 43 Electronic submission of individual case safety reports.

9 44 EudraVigilance Database Modules .. 44 Adverse reaction data collected in the EudraVigilance Post-Authorisation Module .. 44 Adverse reaction data collected in the EudraVigilance Clinical Trial Module .. 45 Preparation of individual case safety reports .. 46 General principles .. 46 Information on suspect, interacting and concomitant medicinal products .. 47 Suspected adverse reactions .. 53 Case narrative, comments and causality assessment .. 55 Test results .. 57 Supplementary records/information .. 58 Follow-up information .. 58 Amendment of cases .. 60 Nullification of 62 Data protection 63 Handling of languages .. 64 Special situations .. 65 Use of a medicinal product during pregnancy or breastfeeding.

10 65 Suspected adverse reaction reports published in the medical literature .. 67 Guideline on good pharmacovigilance practices (GVP) Module VI (Rev 2) EMA/873138/2011 Rev 2 Page 4/144 Suspected adverse reactions related to overdose, abuse, off-label use, misuse, medication error or occupational exposure .. 68 Lack of therapeutic efficacy .. 70 Suspected adverse reactions related to quality defect or falsified medicinal products .. 71 Suspected transmission via a medicinal product of an infectious agent .. 74 Reports of suspected adverse reactions originating from organised data collection systems and other systems .. 75 Receipt of missing minimum information .. 77 Data quality of individual case safety reports transmitted electronically and duplicate management.