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Alj L, Tebaa A, Talibi I, Moubarik S, Benazzouz M, Soulaymani Bencheikh R. Lessons learned from a cluster of immunization errors in newborns. Ther Adv Vaccines Immunother 2024; 12:25151355231221009. [PMID: 38178960 PMCID: PMC10762870 DOI: 10.1177/25151355231221009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
Background Vaccines are safe and effective, but adverse reactions can occur. Immunization errors (IEs) are one of the types of adverse events following immunization. The Moroccan Pharmacovigilance Centre (MPC) received a cluster of IEs from a maternity university hospital (MUH) regarding six newborns who were inadvertently administered rocuronium instead of hepatitis B (HepB) vaccine. The newborns experienced respiratory distress and one had a fatal outcome. Objectives The study aimed to describe the investigation findings, the underlying causes, and contributing factors of the IEs cluster, and proposed risk minimization actions. Design We carried out a descriptive analysis of the cluster of IEs related to the HepB vaccine reported to the MPC. Methods An investigation was conducted by the Ministry of Health according to the World Health Organization guidance. The root cause analysis was performed to identify underlying causes and contributing factors that lead to IE occurrence. Results The cluster analysis showed that the main contributing factors were the look-alike rocuronium and HepB vaccine packaging, the first-time running HepB vaccination for newborns in the MUH, the lack of a full-time pharmacist, and the unsafe storage of rocuronium and vaccines. The administration of Sugammadex to the newborns followed by their transfer to the neonatal care unit resulted in the recovery of five of the six newborns. Proposed recommendations included (1) raising awareness of healthcare professionals to the risk related to look-alike medications, (2) training nurses to ensure vaccination to implement procedures related to immunization practices, (3) nomination of a full-time pharmacist, (4) reassessment of the safety of drug storage and dispensing at the hospital pharmacy, particularly for high-alert medications. Conclusion Reporting IEs, particularly serious ones, allows us to identify causes and contributing factors that led to their occurrence. Lessons learned from errors are key to take risk minimization actions to improve vaccine safety worldwide.
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Affiliation(s)
- Loubna Alj
- Centre Anti Poison et de Pharmacovigilance du Maroc, Ministry of Health and Social Protection, Rue Lamfadel Cherkaoui, Madinate Al Irfane, BP 6671, Rabat, Morocco
- Field Epidemiology Training Program, Ecole Nationale de Santé Publique, Ministry of Health and Social Protection, Rue Lamfadel Cherkaoui, Madinate Al Irfane, BP 6671, Rabat, Morocco
| | - Amina Tebaa
- Centre Anti Poison et de Pharmacovigilance du Maroc, Ministry of Health and Social Protection, Rue Lamfadel Cherkaoui, Rabat, Morocco
| | - Ismail Talibi
- Centre Anti Poison et de Pharmacovigilance du Maroc, Ministry of Health and Social Protection, Rue Lamfadel Cherkaoui, Rabat, Morocco
- Field Epidemiology Training Program, Ecole Nationale de Santé Publique, Ministry of Health and Social Protection, Rue Lamfadel Cherkaoui, Rabat, Morocco
| | - Sofia Moubarik
- Centre Anti Poison et de Pharmacovigilance du Maroc, Ministry of Health and Social Protection, Rue Lamfadel Cherkaoui, Rabat, Morocco
| | - Mohammed Benazzouz
- Direction de la Population, Ministry of Health and Social Protection, Rabat, Morocco
| | - Rachida Soulaymani Bencheikh
- Centre Anti Poison et de Pharmacovigilance du Maroc, Ministry of Health and Social Protection, Rue Lamfadel Cherkaoui, Rabat, Morocco
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Aït Moussa L, Tebaa A, Alj L, Sefiani H, Meski FZ, Khattabi A, Soulaymani Bencheikh R. Adverse drug reactions to chloroquine/hydroxychloroquine in combination with azithromycin in COVID-19 in-patients: data from intensive pharmacovigilance in Morocco, 2020. Naunyn Schmiedebergs Arch Pharmacol 2023; 396:3847-3856. [PMID: 37358793 DOI: 10.1007/s00210-023-02574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
In Morocco, chloroquine/hydroxychloroquine + azithromycin have been used off-label for COVID-19 treatment. This study aimed to describe the distribution, nature and seriousness of the adverse drug reactions (ADRs) associated with the two drug combinations in COVID-19 in-patients. We conducted a prospective observational study based on intensive pharmacovigilance in national COVID-19 patients' management facilities from April 1 to June 12, 2020. Hospitalized patients treated with chloroquine/hydroxychloroquine + azithromycin and who experienced ADRs during their hospital stay were included in the study. The causality and seriousness of the ADRs were assessed using the World Health Organization-Uppsala Monitoring Centre method and the agreed criteria in the ICH guideline (E2A) respectively. A total of 237 (51.7%) and 221 (48.3%) COVID-19 in-patients treated respectively with chloroquine + azithromycin and hydroxychloroquine + azithromycin experienced 946 ADRs. Serious ADRs occurred in 54 patients (11.8%). Gastrointestinal system was most affected both in patients taking chloroquine + azithromycin (49.8%) or hydroxychloroquine + azithromycin (54.2%), followed by nervous system and psychiatric. Eye disorders were more frequent in patients receiving chloroquine + azithromycin (10.3%) than those receiving hydroxychloroquine + azithromycin (1.2%). Cardiac ADRs accounted for 6.4% and 5.1% respectively. Chloroquine + azithromycin caused more ADRs by patients than hydroxychloroquine + azithromycin (2.6 versus 1.5 ADRs/patient). Causality assessment was possible for 75.7% of the ADRs. Diabetes was identified as a risk factor for serious ADRs (ORa 3.56; IC: 95% 1.5-8.6). The off-label use of the two drug combinations in COVID-19 in-patients according to the national therapeutic protocol seems to be safe and tolerable. ADRs were mainly expected. However, precaution should be taken in using the drugs in diabetic patients to prevent the risk of serious ADRs.
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Affiliation(s)
- Latifa Aït Moussa
- Department of Pharmacovigilance, Centre Anti Poison Et de Pharmacovigilance du Maroc, Rue Lamfedel Cherkaoui, Rabat-Institut, Madinat Al Irfane, BP: 6671, Rabat, 10100, Morocco.
- Morocco Field Epidemiology Training Program, Ministry of Health, Rabat, 10100, Morocco.
| | - Amina Tebaa
- Department of Pharmacovigilance, Centre Anti Poison Et de Pharmacovigilance du Maroc, Rue Lamfedel Cherkaoui, Rabat-Institut, Madinat Al Irfane, BP: 6671, Rabat, 10100, Morocco
| | - Loubna Alj
- Department of Pharmacovigilance, Centre Anti Poison Et de Pharmacovigilance du Maroc, Rue Lamfedel Cherkaoui, Rabat-Institut, Madinat Al Irfane, BP: 6671, Rabat, 10100, Morocco
- Morocco Field Epidemiology Training Program, Ministry of Health, Rabat, 10100, Morocco
| | - Houda Sefiani
- Department of Pharmacovigilance, Centre Anti Poison Et de Pharmacovigilance du Maroc, Rue Lamfedel Cherkaoui, Rabat-Institut, Madinat Al Irfane, BP: 6671, Rabat, 10100, Morocco
| | - Fatima Zahra Meski
- Morocco Field Epidemiology Training Program, Ministry of Health, Rabat, 10100, Morocco
- Ecole Nationale de Santé Publique, Rabat, 10100, Morocco
| | - Asmae Khattabi
- International School of Public Health, Mohammed VI University of Sciences & Health, Casablanca, Morocco
- Laboratory of Management and Public Health, Mohammed VI Center for Research & Innovation, Rabat, Morocco
| | - Rachida Soulaymani Bencheikh
- Department of Pharmacovigilance, Centre Anti Poison Et de Pharmacovigilance du Maroc, Rue Lamfedel Cherkaoui, Rabat-Institut, Madinat Al Irfane, BP: 6671, Rabat, 10100, Morocco
- Laboratoire de Pharmacologie Et Toxicologie, Faculté de Médecine Et de Pharmacie, Université Mohammed V, Rabat, 10100, Morocco
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Tebaa A, Benkirane R, Alj L, Cherkaoui I, Soulaymani-Bencheikh R. Monitoring the safety of influenza A/H1N1 pandemic and seasonal vaccines in Morocco. Ther Adv Vaccines Immunother 2022; 10:25151355221088157. [PMID: 35372783 PMCID: PMC8968976 DOI: 10.1177/25151355221088157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A vaccination campaign against pandemic influenza A/H1N1 was implemented in Morocco between November 2009 and April 2010. Overall, 705,883 subjects were vaccinated by Pandemrix, Arepanrix, and Panenza. The adverse events following immunization (AEFIs) data comparison was made with the 2014/2015 seasonal influenza vaccination campaign that was specifically investigated. Aim: To evaluate the safety of the 2009 pandemic influenza A/H1N1 vaccine and to compare it to that of 2014 seasonal influenza vaccine. Methods: During the pandemic vaccination campaign, the Morocco Pharmacovigilance Centre reinforced passive AEFI surveillance with an active and prospective monitoring programme of 1000 immunized people over 6 months at 10 randomly selected vaccination centres. For the 2014/2015 seasonal vaccination campaign, AEFI data were collected from spontaneous notifications. Results: Active monitoring of 2009 pandemic collected 771 AEFI reports, corresponding to an AEFI incidence rate of 77.1% with vaccination by either Pandemrix or Arepanrix vaccine in 95% of cases. Reported AEFI were most frequently local (37.7%), general (29.5%), and neurological reactions (20.3%). Most of the AEFI (95.5%) were observed during the first 48 hours after vaccination, and the remainder within 2 weeks. None of the reported AEFI were serious case. The highest rate of notification was documented for health professionals, followed by patients with diabetes or chronic respiratory diseases. Concerning passive surveillance, the AEFI notification rate was significantly higher for the 2009/2010 pandemic vaccine (3.1 vs 1.2 per 10,000). However, there was no significant difference between pandemic and seasonal vaccination with regards to the serious adverse events (SAE) notification rate (0.3 vs 0.2 per 10,000). Conclusion: Data analysis indicates that the vaccines used against 2009 pandemic influenza in Morocco have a satisfactory safety profile, similar to the seasonal influenza vaccine with the exception of local reactions as observed previously in other countries.
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Affiliation(s)
- Amina Tebaa
- Centre Anti Poison et de Pharmacovigilance du Maroc (CAPM), Ministry of Health, Rue Lamfedel Cherkaoui, Rabat Instituts, Madinate Al Irfane, B.P. 6671, Rabat 10100, Morocco
| | - Raja Benkirane
- Ecole Nationale de Santé Publique (ENSP), Ministry of Health, Rabat, Morocco
| | - Loubna Alj
- Centre Anti Poison et de Pharmacovigilance du Maroc (CAPM), Ministry of Health, Rabat, Morocco
| | - Imad Cherkaoui
- Direction de l’Epidemiologie et de Lutte contre les Maladies (DELM), Ministry of Health, Rabat, Morocco
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Bechar H, Attjioui H, Mimouni H, Ismaili R, Tebaa A, Belahcen J, Rahali Y. Materiovigilance in health centers: The role of notifiers to ensure safer use of medical devices. Ann Pharm Fr 2021; 80:301-311. [PMID: 34571010 DOI: 10.1016/j.pharma.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 07/12/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The implementation of efficient health and vigilance strategy is one of the essential aspects of the health policy of public and private health establishments, in order to reduce the risk of incidents due to medical devices. AIM The objective of this study is to demonstrate the importance of user notification and to recognize the role of nursing staff in the materiovigilance process. METHODS This is a retrospective study of materiovigilance cases notified for three years (2016, 2017, and 2018) at the National Institute of Oncology. The evaluation of the incidents was carried out with the aim of taking the necessary measures to prevent and minimize risk. RESULTS Seven thousand three hundred and eight cases of materiovigilance during the 3 years were collected. A spontaneous collection of reports was predominant (70%). The distribution of the number of incidents by the profile of notifiers shows that reports come from surgeons and much more from nurses. The surgical block (35.7%) and medical oncology services (14.3%) were the services that reported more; the majority of the observed adverse events were attributed to infusion sets (n=7105). Four serious cases of materiovigilance. reported during these 3 years at the level of the vigilance unit considered the most relevant were detailed with examples of immediate actions taken and risk minimization actions. CONCLUSION This study highlights the characteristics of incidents reported. The role of the nursing staff and the strong presence of nurses in the vigilance system has been well demonstrated, thus reducing the risk of side effects due to medical devices.
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Affiliation(s)
- H Bechar
- National Institute of Oncology, Ibn Sina University Hospital Center, 10170 Rabat, Morocco
| | - H Attjioui
- Mohammed V University in Rabat- Faculty of Medicine and Pharmacy of Rabat, 10170 Rabat, Morocco.
| | - H Mimouni
- National Institute of Oncology, Ibn Sina University Hospital Center, 10170 Rabat, Morocco; Hassan First University of Settat , Morocco
| | - R Ismaili
- National Institute of Oncology, Ibn Sina University Hospital Center, 10170 Rabat, Morocco; Hassan First University of Settat , Morocco
| | - A Tebaa
- Ministry of Health, Poison Control Center of Morocco, 10170 Rabat, Morocco
| | - J Belahcen
- National Institute of Oncology, Ibn Sina University Hospital Center, 10170 Rabat, Morocco
| | - Y Rahali
- National Institute of Oncology, Ibn Sina University Hospital Center, 10170 Rabat, Morocco; Team of Formulation and Quality Control of Health Products, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, National Institute of Oncology, Ibn Sina University Hospital Center, 10170 Rabat, Morocco
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Belamalem S, Tebaa A, Khadmaoui A, Abdelrhani M, Soulaymani A, Soulaymani-Bencheik R. Les caractéristiques épidémiologiques du nécrolyse épidermique chez l’adulte. ARCH MAL PROF ENVIRO 2020. [DOI: 10.1016/j.admp.2019.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Heininger U, Holm K, Caplanusi I, Bailey S, Asfijah Abdoellah S, Arellano F, Arlett P, Ayoub A, Sjafri Bachtiar N, Bahri P, Bailey SR, Benkirane R, Benson J, Bergman U, Blum M, Bonhoeffer J, Caplanusi I, Ceuppens M, Chandler R, Glen Chua P, Dana A, Darko M, DeStefano F, Dodoo A, Duo D, Gregory W, Gunale B, Hartigan-Go K, Hartmann K, Heininger U, Jadhav S, Jouquelet-Royer C, Keller-Stanislawski B, Kilpi T, Kurz X, Leviano F, Lindquist M, Liu D, Mandali P, Mangrule S, Maroko R, Martin D, Matos dos Santos E, Maure C, Menezes R, Nishioka S, Oberle D, Olsson S, Patel M, Ramkishan A, Rauscher M, Santos P, Seifert H, Shimabukuro T, Sillan F, Sjölin-Forsberg G, Srivastava S, Straus W, Tebaa A, Winiecki S, Vellozzi C, Wivel A, Xia W, Hassan Abu Youssef M, Zuber P. Guide to active vaccine safety surveillance: Report of CIOMS working group on vaccine safety – executive summary. Vaccine 2017. [DOI: 10.1016/j.vaccine.2017.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bouazzi OE, Hammi S, Bourkadi JE, Tebaa A, Tanani DS, Soulaymani-Bencheikh R, Badrane N, Bengueddour R. First line anti-tuberculosis induced hepatotoxicity: incidence and risk factors. Pan Afr Med J 2016; 25:167. [PMID: 28292129 PMCID: PMC5326068 DOI: 10.11604/pamj.2016.25.167.10060] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/04/2016] [Indexed: 11/11/2022] Open
Abstract
In our days, tuberculosis, whet ever its localization, became a curable disease. The cornerstone is a 6 month course of isoniazid, rifampicine and pyrazinamide. All of the three first line antituberculosis drugs may induce hepatic damage which may have negative consequences for treatment outcome. Several risk factors were associated with the development of antituberculosis- drug-induced hepatotoxicity (ATDH). A retrospective study was conducted from July 2014 to March 2015 regarding all therapeutic drug-monitoring requests sent to the Laboratory of Poison Control and Pharmacovigilance Centre of Morocco. 142 patients diagnosed with active tuberculosis were included in study. Plasma peak levels of isoniazid, rifampicin and pyrazinamide were analyzed in plasma samples after 2 to 3 hours of administration of anti-tuberculosis treatment. Logistic regression was used to identify the ATDH risk factors. The incidence of ATDH was found 24.6% (35 patients out of 142). Intergroup differences in the plasma levels were statistically significant for isoniazid (p=0.036). ATDH was found to be associated with combined form of anti-TB drugs (p=0.002, COR=13.1, AOR= 13.5) and plasma concentration of INH superior to 2mg/l (p=0.045, COR=1.3, AOR= 1.4).age, gender, alcohol intake and smoking status were not significantly associated with ATDH. The finding of 24.6% incidence of hepatotoxicity is extremely high. Many factors can be associated with the development of ATDH such as genetic factors, combined forms of treatment and plasma peak levels.
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Affiliation(s)
- Omaima El Bouazzi
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc; Faculté des Sciences, Universités Ibn Tofail, Kénitra, Maroc
| | - Sanaa Hammi
- Faculté de Médecine et de Pharmacie, Université Abd El Malek Essadi, Tanger, Maroc; Hôpital Moulay Youssef, Rabat, Maroc
| | - Jamal Eddine Bourkadi
- Hôpital Moulay Youssef, Rabat, Maroc; Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Amina Tebaa
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc
| | - Driss Soussi Tanani
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc; Faculté de Médecine et de Pharmacie, Université Abd El Malek Essadi, Tanger, Maroc
| | - Rachida Soulaymani-Bencheikh
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc; Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Narjis Badrane
- Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc; Faculté des Sciences, Universités Ibn Tofail, Kénitra, Maroc
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Guaoua S, Ratbi I, El Bouazzi O, Hammi S, Tebaa A, Bourkadi JE, Bencheikh RS, Sefiani A. NAT2 Genotypes in Moroccan Patients with Hepatotoxicity Due to Antituberculosis Drugs. Genet Test Mol Biomarkers 2016; 20:680-684. [DOI: 10.1089/gtmb.2016.0060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Soukaina Guaoua
- Centre de Génomique Humaine, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
- Département de Génétique Médicale, Institut National d'Hygiène, Rabat, Morocco
| | - Ilham Ratbi
- Centre de Génomique Humaine, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
| | - Omaima El Bouazzi
- Laboratoire de Pharmacotoxicologie, Centre Anti Poison et de Pharmacovigilance, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
- Faculté des Sciences, Université Ibn Tofail, Kénitra, Morocco
| | - Sanaa Hammi
- Faculte de Médecine, Université Abdel Malek Essaadi, Tanger, Morocco
| | - Amina Tebaa
- Laboratoire de Pharmacotoxicologie, Centre Anti Poison et de Pharmacovigilance, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
| | - Jamal Eddine Bourkadi
- Département de Pneumologie, Hôpital Moulay Youssef - Centre Hospitalier Ibn Sina Rabat, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
| | - Rachida Soulaymani Bencheikh
- Laboratoire de Pharmacotoxicologie, Centre Anti Poison et de Pharmacovigilance, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
| | - Abdelaziz Sefiani
- Centre de Génomique Humaine, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
- Département de Génétique Médicale, Institut National d'Hygiène, Rabat, Morocco
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Beigel J, Kohl KS, Brinley F, Graham PL, Khuri-Bulos N, LaRussa PS, Nell P, Norton S, Stoltman G, Tebaa A, Warschaw K. Generalized vaccinia as an adverse event following exposure to vaccinia virus: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2007; 25:5745-53. [PMID: 17537552 DOI: 10.1016/j.vaccine.2007.02.086] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- John Beigel
- NIH Clinical Center, National Institute of Health, Bethesda, MD, USA
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Tebaa A, Daouda A, Benkirane R, Soulaymani R. Perception of Pharmacovigilance by Health Professionals: A Survey Conducted in Rabat. Drug Saf 2007. [DOI: 10.2165/00002018-200730100-00075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Tebaa A, Daouda A, Benkirane R, Soulaymani R. Physician???s Attitude and Behaviour Related to Voluntary Reporting ADRs. Drug Saf 2006. [DOI: 10.2165/00002018-200629100-00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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