Aims:　Botulinum　toxin　type　A　(BoNT-A)　is　widely　used　for　its　efficacy　in　treating　a　variety　of　neuromuscular　disorders.　However,　data　on　its　safety　and　adverse　events　(AEs)　in　real-world　settings　remain　limited.　The　Food　and　Drug　Administration　Adverse　Event　Reporting　System　(FAERS)　database　provides　an　invaluable　resource　for　evaluating　the　safety　of　BoNT-A.　Methods:　We　used　four　methods　to　evaluate　the　disproportionality　of　AEs　associated　with　BoNT-A:　the　reporting　odds　ratio　(ROR),　the　proportional　reporting　ratio　(PRR),　the　Bayesian　confidence　propagation　neural　network　(BCPNN),　and　the　multi-item　gamma　Poisson　shrinker　(MGPS).　Results:　Among　the　17　307　196　case　reports　in　the　FAERS　database,　there　were　69　644　reports　where　BoNT-A　was　listed　as　the　“primary　suspect”　for　AEs.　BoNT-A-related　AEs　affected　27　system　organ　classes　(SOCs).　Based　on　the　four　algorithms,　290　significant　disproportionalities　at　the　Preferred　Term　(PT)　level　were　retained.　Unexpected　AEs,　such　as　skin　wrinkles,　hyperacusis,　Guillain-Barré　syndrome,　mediastinitis　and　infective　aneurysm,　were　identified,　which　are　not　mentioned　in　the　product　insert.　Conclusion:　This　study　provides　an　overview　of　AEs　in　the　real-world　use　of　BoNT-A,　revealing　its　broad　safety　profile.　Although　the　majority　of　AEs　were　mild　to　moderate,　there　is　a　need　to　remain　vigilant　for　serious　AEs　and　to　monitor　them　in　clinical　practice.　©　2025　British　Pharmacological　Society.