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In November 2013, 17-year-old Torin Yater-Wallace suffered a penetrating right lung injury caused by dry needling performed by a physical therapist. The penetrating right lung injury resulted in a traumatic pneumothorax (an accumulation of air in the pleural cavity resulting from blunt or penetrating chest injury and causing lung collapse). He was treated for the traumatic pneumothorax at the emergency department of the St. Anthony Summit Medical Center in Frisco, Colorado, and was admitted to that hospital on the same day. The traumatic pneumothorax required medical and surgical intervention. He was hospitalized for five days. (Photo: @TorinWallace)

 
 
 

Dry Needling Adverse Event Reporting System (DNAERS) Form

To report a serious adverse event caused by dry needling performed by an unqualified practitioner of acupuncture, such as a physical therapist, use the Dry Needling Adverse Event Reporting System (DNAERS) form. The National Center for Acupuncture Safety and Integrity (NCASI) will use the information as part of our legislative and administrative advocacy work.

Note: Fields marked with an asterisk (*) are required.

Section I: Patient Information
Patient Name *
Patient Name
Street Address *
Street Address
Telephone Number *
Telephone Number
Date of Birth *
Date of Birth
Sex *
Section II: Reporter Information
(If different from Patient Information)
Reporter Name
Reporter Name
Street Address
Street Address
Telephone Number
Telephone Number
Relation to Patient
Section III-A: Dry Needling Provider Information
Dry Needling Provider Name *
Dry Needling Provider Name
Occupation *
Section III-B: Dry Needling Facility/Clinic Information
Street Address *
Street Address
Telephone Number *
Telephone Number
http://
Section IV: Dry Needling Adverse Event Information
Date of Dry Needling *
Date of Dry Needling
Outcome(s) of the Dry Needling Adverse Event *
(Check all that apply)
(Include as many details as possible)
Date of This Report *
Date of This Report

We will contact you if we have additional questions.