Pharmacovigilance


In order to collect the information of suspected adverse drug reactions in the process of drug use more actively, safely and effectively. If any adverse drug reaction/event occurs when using our products, please fill in the information about the adverse drug reaction online or contact us by telephone:

Tel: 86-593-8361742

Case Adverse Drug Reaction Event Information Table


Patient Information

*Patient Name:

*Date of Birth:

*Weight:

*Contact:

*Gender:

*Medical Institution:

*Primary disease:

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Suspected drug information

*Drug Name:

*Drug Lot#:

*Approval Number:

*Reason:

*Start:

*End of medication:

Usage:

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Concomitant medication information

Drug Name:

Approval Number:

Specifications:

Product lot number:

Usage:

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Concomitant Medication Start Time:

Concomitant Medication End Time:

Adverse reaction information

*Adverse reaction name:

*Occurrence:

End Time:

*Vesting:

Stop/Reduction Symptoms:

Severity:

*ADR Process Description:

Reporter Information

*Name of reporter:

Reporter Profession:

Attachments:

Please upload files in RAR or ZIP format
Submission