Drug safety

Form for submitting initial information on adverse drug reaction

All fields marked with asterix (*) must be completed.

EN Форма нежелана реакция (#8)

PATIENT *

It is mandatory to fill one of the following fields

ADVERSE DRUG REACTION (ADR)

Outcome of adverse drug reaction

(if you think it is important)

SUSPECTED DRUG PRODUCT

(name, daily dose, indications)

INTAKE OF OTHER NON-SUSPECT DRUG PRODUCTS:

(name, daily dose, indications )

DATA ON SUBMITTING PERSON

Contact form

Contact Form EN (#5)

Fields marked with an asterisk (*) are required.