1	Adverse Drug Reaction (ADR)	Relevant? Yes, No	Present? Yes, No
A	Proper description of the ADR	Yes a
B	Specification reaction ‘localization’ and ‘characterization’ To ‘strengthen the diagnosis (subdomain c or d or e applicable):
C	Treatment; or
D	Visual material (photo, video); or
E	Lab values, test
2	Chronology	Relevant? Yes, no	Present? Yes, no
A	Latency	Yes a
B	Description of the course of the ADR
C	Action taken on drug	Yes a
D	Outcome of the ADR	Yes a
3	Suspected drug	Relevant? Yes, no	Present? Yes, no
A	Brand name in case of drug substitution?
B	Different forms or route of administration for suspected drug?
C	Dose-relationship with ADR?
D	Batch number of relevance?
4	Patient characteristics	Relevant? Yes, no	Present? Yes, no
A	Risk factors/medical history/comorbidity/indication
B	Concomitant medication	Yes a
C	Age/gender/length/weight
D	Patient’s lifestyle or other risk factors
a: always relevant, Calculation of score: domain score: Number of present subdomains/number of relevant subdomains * 100%, Final score: Average relevant domain scores, Cut off values: Poorly (≤45%), moderately (from 46–74%) and well (≥75%).