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 Карта-повідомлення для медичних працівників (en)

    1. GENERAL INFORMATION

    Sex:

    Outcome of adverse reaction/lack of efficacy: *

    Onset of adverse reaction/lack of efficacy:

    End of adverse reaction/lack of efficacy:

    2. SUSPECTED DRUG INFORMATION
    3. INFORMATION ON CONCOMITANT MEDICINAL PRODUCTS
    (excluding medicinal products used to treat the consequences of the adverse reaction)
    4. TREATMENT OF ADVERSE REACTION

    Did the withdrawal of the suspect medicinal product lead to the resolution of the adverse reaction?

    Was a recurrence of the adverse reaction observed after rechallenge?

    Was a recurrence of the adverse reaction observed after dose adjustment?

    5. INFORMATION ON THE REPORTER

    Your message надає: *