Patient safety and the general efficacy of pharmacovigilance are negatively impacted by the underreporting of adverse drug reactions (ADRs), which present a substantial challenge to the healthcare system. This study combines data from multiple healthcare settings to investigate the scope, reasons, and effects of underreporting of adverse drug reactions. Under-reporting can be caused by a number of factors, such as time restrictions, legal fear, lack of understanding among healthcare providers, and complicated reporting systems. In order to provide real-time ADR monitoring, the study emphasises the necessity of streamlining reporting procedures, improving healthcare providers education and training, and integrating cutting-edge technology. The article discusses suggestions for raising reporting rates and making sure there is a stronger pharmacovigilance framework. Resolving these concerns is essential to improving patient care outcomes and medication safety.