Background Adverse Event Reporting Systems (AERS) are essential tools for improving patient safety, yet under-reporting by medical staff remains a persistent challenge. Existing studies mainly adopt variable-centered approaches and overlook the heterogeneity of healthcare professionals' system perceptions. This study aimed to identify latent profiles of medical staff's perceptions of AERS and examine their associations with adverse event reporting intention.Methods A cross-sectional survey was conducted among 637 medical staff from seven tertiary hospitals in Hangzhou, China, in March 2026. Perceptions of AERS were measured across five dimensions: perceived usefulness, perceived ease of use, perceived interactivity, perceived risk, and technical support. Latent Profile Analysis (LPA) was performed using Mplus 8.3 to classify perception patterns. Differences in demographic characteristics and reporting intention across profiles were examined, and generalized linear regression was used to assess the relationship between perception profiles and reporting intention.Results Three distinct perception profiles were identified: Low-Perception (16.95%), Moderate-Perception (56.99%), and High-Perception (26.06%). Significant differences in sex, professional position, and employment status were observed across profiles (P β = 0.220, P β = 0.404, P Conclusions Medical staff demonstrate substantial heterogeneity in their perceptions of AERS, and more positive perception profiles are strongly associated with higher reporting intention. Targeted strategies focusing on improving system usability, strengthening technical and organizational support, and reducing perceived reporting risk may enhance staff engagement in adverse event reporting and contribute to patient safety improvement.