Box 2. WHO–UMC causality categories.

Causality term	Assessment criteria
Certain	• Event or laboratory test abnormality, with plausible time relationship to drug intake • Cannot be explained by disease or other drugs • Response to withdrawal plausible (pharmacologically, pathologically) • Event definitive pharmacologically or phenomenologically (i.e. an objective and specific medical disorder or a recognised pharmacological phenomenon) • Rechallenge satisfactory, if necessary
Probable/Likely	• Event or laboratory test abnormality, with reasonable time relationship to drug intake, Unlikely to be attributed to disease or other drugs • Response to withdrawal clinically reasonable • Rechallenge not required
Possible	• Event or laboratory test abnormality, with reasonable time relationship to drug intake • Could also be explained by disease or other drugs • Information on drug withdrawal may be lacking or unclear
Unlikely	• Event or laboratory test abnormality, with a time to drug intake that makes a relationship improbable (but not impossible) • Disease or other drugs provide plausible explanations
Conditional/ Unclassified	• Event or laboratory test abnormality • More data for proper assessment needed, or • Additional data under examination
Unassessable/ Unclassifiable	• Report suggesting an adverse reaction • Cannot be judged because information is insufficient or Contradictory • Data cannot be supplemented or verified

Reference The Uppsala Monitoring Center. The use of the WHO-UMC system for standardised case causality assessment. Reproduced with permission of Uppsala monitoring centre. Available at https://www.who-umc.org/media/2768/standardised-case-causality-assessment.pdf