| Question | Answer | Score |
| 1. Are there previous conclusive reports on this reaction? | Yes | +1 |
| 2. Did the adverse event occur after the suspected drug was administered? | Yes | +2 |
| 3. Did the adverse reaction improve when the drug was discontinued, or a specific antagonist was administered? | Yes | +1 |
| 4. Did the adverse reaction reappear when the drug was readministered? | Yes | +2 |
| 5. Are there alternative causes (other than the drug) that could have on their own caused the reaction? | Yes | −1 |
| 6. Did the reaction reappear when a placebo was given? | Do not know/ not done | −1 |
| 7. Was the blood detected in the blood (or other fluids) in concentrations known to be toxic? | No | 0 |
| 8. Was the reaction more severe when the dose was increased or less severe when the dose was decreased? | Do not know/ not done | 0 |
| 9. Did the patient have a similar reaction to the same or similar drugs in any previous exposure? | Yes | +1 |
| 10. Was the adverse event confirmed by any objective evidence? | Yes | +1 |
| Total Score | 6 | |