For a side-effect to become a safety signal, a certain number of similar reports must cluster in the national PV database, the PvPI. Most reactions go unreported because the system relies on a busy doctor to file the form—a task often lost in the *dhak-dhak* of an overcrowded OPD. I know this gap well; last week, my own *Dada* dismissed his new medicine's giddiness as mere *kamjori*, and no one at the primary health centre had the time to listen, let alone report. The obvious answer is lack of awareness, but my life in a Jharkhand village says it’s the crushing workload on our frontline workers that silences these stories first.
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