United Kingdom · Reporting preparation
Prepare a GLP-1 symptom diary for a Yellow Card report
Keep observations, medicine details and follow-up notes together before opening the official MHRA reporting service.
A clear account starts with a few dated facts
A symptom diary can help you remember a sequence when you want to discuss a GLP-1 medicine concern or report it. Record what you noticed, when you first noticed it and what happened afterwards. Use your own description rather than choosing a medical term you are unsure about. The aim is to make your experience understandable, not to prove a cause.
Get medical advice for concerning symptoms and urgent help when needed. A reporting worksheet is not a way to obtain treatment instructions. Do not wait until every field is filled in before seeking care.
Know what the UK reporting service does
GOV.UK’s Yellow Card entry page says anyone can report a suspected problem. Examples include side effects, poor-quality medicines and concerns about counterfeit products. The service cannot give medical advice. Its medicines reporting route is separate from some medical-device routes, so begin with the official page and choose the appropriate category.
The MHRA’s Yellow Card guidance explains the scheme for patients, the public and health professionals. Use the current instructions for your report rather than treating a downloaded personal worksheet as an official form.
Separate the product record from the symptom timeline
Make one section for the medicine: the exact name, formulation, pack details and batch if available. Then use dated notes for the event. Keep the pharmacy receipt or pack photograph somewhere you can retrieve it, and write its location on the sheet. A photograph can help you read small print later; it cannot establish authenticity by itself.
In the timeline, note whether times are exact or approximate. Add relevant contacts with a pharmacist or clinician and clearly identify their advice. If you later remember another detail, add a dated correction rather than rewriting the first note as if you knew it then.
Yellow Card preparation worksheet
Download blank worksheet (CSV)
Print this page to write by hand, or open the CSV in a spreadsheet. Leave unknown details blank. This worksheet does not submit information.
| Field | My notes |
|---|---|
| Medicine name, formulation and pack details | |
| Batch and source of product information | |
| First symptom and approximate or exact onset | |
| Subsequent changes and daily impact | |
| Relevant recorded administrations | |
| Other medicines or context to discuss | |
| Healthcare contact and advice received | |
| Date reported and acknowledgement reference |
Review, report and keep the acknowledgement
Illustrative wording: “I noticed this on Monday evening; I cannot remember the exact time. I contacted my pharmacist the next morning.” That is more informative than an unsupported statement that a medicine definitely caused the event. It also makes uncertainty visible to the person reading it.
Read the official form carefully and share information through the official service. GOV.UK explains that you receive confirmation and may be contacted for more information. Save that confirmation beside your own notes. The CSV here neither uploads to Yellow Card nor guarantees that an individual case will be investigated.
Keep your ongoing treatment record separate from the submitted report. If your care team gives updated instructions, record where to find them and whom to contact with questions. A report reference does not authorise a medication change.