Navigating the FDA’s website can pose challenges. Search functionality is iffy, data can be buried on unexpected sub-pages, and there just is a lot of material there.
Adverse event report information historically has been spread across six systems:
- FAERS (FDA Adverse Event Reporting System) — containing reports for drugs, biologics, cosmetic products, and color additives.
- VAERS (Vaccine Adverse Event Reporting System) — containing reports for vaccines (co-managed by FDA and Centers for Disease Control and Prevention).
- AERS (Adverse Event Reporting System) — two databases containing reports for animal drugs and animal foods.
- MAUDE (Manufacturer and User Facility Device Experience) — containing reports for medical devices.
- HFCS (Human Foods Complaint System) — containing reports for human foods and dietary supplements.
- CTPAE (Center for Tobacco Products Adverse Event Reporting System) — containing reports for Electronic Nicotine Delivery Systems (ENDS) and other tobacco products.
By end of May, all of these adverse event reporting systems will be shut down, and adverse event information will be wrapped up into a single “Adverse Event Monitoring System” or “AEMS”. The FDA’s press release is here. The new public dashboard is here (but the device, food, and tobacco portions are not yet operational).
According to the website, AEMS will cover more than adverse events, serving “as a centralized platform for managing consumer complaints, regulatory misconduct reports, and whistleblower submissions across all FDA centers.”
For our drug and device litigation purposes, the new system contains useful express caveats about the use (or mis-use) of adverse event information. The dashboard landing page starts it off by stating:
AEMS Data Limitations
While the FDA AEMS Public Dashboard offers stakeholders many more ways of searching for and organizing data on adverse events reported to the FDA, there remain limitations to the data. For example, while AEMS contains reports on a particular drug or biologic, this does not mean that the drug or biologic caused the adverse event. Importantly, the AEMS data by themselves are not an indicator of the safety profile of a product. Some additional limitations to note include:
1. Duplicate and incomplete reports are in the system: There are many instances of duplicative reports and some reports do not contain all the necessary information.
2. Existence of a report does not establish causation: For any given report, there is no certainty that a suspected product caused the event. While consumers and healthcare professionals are encouraged to report adverse events, the event may have been related to the underlying disease being treated, or caused by some other drug being taken concurrently, or occurred for other reasons. The information in these reports reflects only the reporter’s observations and opinions.
3. Information in reports has not been verified: Submission of a report does not mean that the information included in it has been confirmed nor it is an admission from the reporter that the product caused or contributed the event.
4. Rates of occurrence cannot be established with reports: The information in these reports cannot be used to estimate the incidence (occurrence rates) of the events reported.
5. Patients should talk to their doctor before stopping or changing how they take their medications.
Even better, to access AEMS, a user has to affirmatively accept the terms outlined in a pop-up disclaimer, which reads as follows (with some emphasis added):
Disclaimer
Each year, the FDA receives over two million adverse event and medication error reports associated with the use of drugs and biologic products. The FDA uses these reports to monitor the safety of drug and biologic products through the FDA Adverse Event Monitoring System (AEMS) database, which houses reports submitted by drug manufacturers (who are required to submit these reports) as well as healthcare professionals and consumers. It is important to note that submission of a safety report does not constitute an admission that medical personnel, user facility, importer, distributor, manufacturer, or product caused or contributed to the event.
Although these reports provide valuable information, this surveillance system has inherent limitations. Reports may contain incomplete, inaccurate, untimely, and/or unverified information. Additionally, the true incidence or prevalence of an event cannot be determined from this reporting system alone due to potential under-reporting and lack of information about frequency of use. Because of these limitations, AEMS data comprise only one component of the FDA’s comprehensive post-market surveillance program, and the information does not confirm a causal relationship between the drug or biologic product and the reported adverse event(s).
American public (or consumers) should be aware of several important considerations when interpreting AEMS data.
– Consumers should not stop or change medication without first consulting with a health care professional.
– AEMS data alone cannot be used to establish event rates, evaluate changes in event rates over time, or compare event rates between products.
– The number of reports cannot be interpreted in isolation to reach conclusions about the existence, severity, or frequency of problems associated with drug products.
– Confirming whether a drug product caused a specific event can be difficult based solely on information provided in each report.
– Therefore, AEMS data should be interpreted in the context of other available information when making drug or biologic-related treatment decisions.
The AEMS web search feature covers adverse event reports from 1968 to present, with data submitted to AEMS made available daily (near real-time) through the online querying tool. However, variations in trade, product, and company names affect search results, as searches only retrieve records containing the specific search terms provided. Safety reports submitted to FDA do not necessarily reflect a conclusion by FDA that the information constitutes an admission that the drug or biologic caused or contributed to an adverse event.
Because AEMS users have to accept the disclaimer terms to access data, any plaintiff-side expert who attempts to rely on adverse event data to support causation opinions will be vulnerable to cross-examination about how they explicitly acknowledged that adverse event reports “may contain incomplete, inaccurate, untimely, and/or unverified information” and “[do] not confirm a causal relationship between the drug or biologic product and the reported adverse event(s).”
Hopefully, this pop-up disclaimer language will be updated soon to include more than just “drug or biologic” products as AEMS will cover medical devices and vaccines as well.
But we appreciate its inclusion, and that assent is required for access. It won’t end plaintiffs’ experts from misusing adverse event data, but it does give us good fodder for cross and the Rule 702 motions that follow.