srjcmsSRJCMSSRJCMS2788-885110.47310/srjcms.2025.v05i01.018Side Effects in the Shadows: Evaluating Public Awareness of Adverse Drug Reactions (ADR) and Reporting Systems in MandiBackground: Adverse drug reactions (ADRs) significantly impact patient safety and healthcare costs worldwide, making pharmacovigilance a critical public health function. Despite national initiatives like the Pharmacovigilance Programme of India (PvPI), public awareness regarding ADR recognition and reporting remains low, particularly in rural and semi-urban areas. This study aimed to assess the knowledge, perceptions and practices related to ADRs and pharmacovigilance among residents of Mandi district, Himachal Pradesh. Materials and Methods: A descriptive, cross-sectional survey was conducted from January to March 2025, targeting 400 adult residents across urban and rural areas of Mandi. Participants were selected using purposive and snowball sampling techniques. Data were collected through a structured, bilingual questionnaire covering demographics, ADR knowledge, awareness of pharmacovigilance systems and reporting practices. Responses were scored and categorized into Very Good (≥80%), Good (60-79%), Fair (41-59%) and Poor (<40%) knowledge levels. Statistical analysis was performed using SPSS version 26.0. Results: The majority of participants were young to middle-aged adults, with a predominance of rural residents (65.3%). While 77.0% correctly identified ADRs and 79.3% recognized their potential severity, only 60.3% were aware of pharmacovigilance and just 59.8% knew that patients could report ADRs directly to PvPI. Knowledge levels were categorized as Good in 42.8% and Very Good in 29.5% of respondents, but 27.8% demonstrated Fair or Poor understanding. Gaps were particularly notable in awareness of reporting channels, the risks of combining herbal remedies with modern medicines and recognizing ADRs among vulnerable populations. Conclusion: Although the Mandi population exhibits encouraging foundational awareness of ADRs, critical knowledge and behavioral gaps persist, especially regarding formal reporting systems and patient-led pharmacovigilance participation. Targeted, community-based education campaigns, integration of ADR counseling in clinical practices and the promotion of accessible, patient-friendly reporting tools are urgently needed to strengthen pharmacovigilance and improve medication safety outcomes in semi-urban and rural settings.