State Government of Victoria, Australia

Department of Health

The * symbol indicates required information

The symbol indicates field level help is available.

Any data submitted using this electronic form via the Internet is secure and will be encrypted using SSL (Secure Sockets Layer)

The Serious Transfusion Incidents Reporting (STIR) system is a central reporting system for serious adverse events with transfusion of blood or blood components including near-miss incidents.

Please use this form to report serious incidents with transfusion of fresh blood and blood components. Confidentiality of data is fundamental to the success of this scheme. We have not requested unique patient indentification details. We will contact you to obtain additional details if necessary.

Key details of incident

Patient Details

you may check more than one box

Nature of Incident  

Clinical Reaction


Reporters Details

Privacy Notification  Printable Form