Background <p>Adverse drug reactions (ADRs) are still a big worry for patient safety all over the world. Pharmacovigilance systems in India are well-established, but there is still not much data coming from healthcare institutions that mainly serve rural areas. To find gaps in ADR reporting and suggest specific improvements, it is important to understand how pharmacovigilance works in these kinds of institutions.</p> Methods <p>A descriptive, cross-sectional questionnaire-based study was performed among healthcare professionals and students at Government Medical College, Baramulla, a tertiary care institution primarily serving rural populations in North Kashmir. We used convenience sampling to reach a total of 350 people, and 326 of them filled out the survey (response rate: 93.1%). Descriptive statistics were used to look at the data.</p> Results <p>Participants exhibited a satisfactory understanding of pharmacovigilance principles (70% accurately defining pharmacovigilance) and overwhelmingly favourable attitudes towards ADR reporting (over 90% acknowledging it as a professional obligation). But only 22.6% of them had ever reported an ADR. The most common problems that people reported were not being able to find ADRs (37.2%), not having enough time (26.6%), and being worried about legal liability (13.8%). People had different levels of knowledge about national pharmacovigilance systems, mostly when it came to how to report problems.</p> Conclusion <p>Even though people have good knowledge and positive attitudes, ADR reporting practices are still not good enough in this institution, which shows that there is a clear gap between what people know and what they do. To close this gap, we may need to improve training, make institutional support systems stronger, and make pharmacovigilance a regular part of clinical work.</p>