A cross-database pharmacovigilance analysis found significant reporting associations between fulvestrant and respiratory adverse events, including pleural effusion and interstitial lung disease. The work flags that rare but clinically serious pulmonary toxicities may warrant closer attention during real-world prescribing. Pharmacovigilance studies like this are most actionable when clinicians and pharmacovigilance teams integrate signals into monitoring protocols—particularly for patients with baseline pulmonary risk factors. For biotech and med affairs teams, the focus is on strengthening risk communication and evaluating whether label language, surveillance plans, or patient selection criteria need refinement.