PHARMACOVIGILANCE

REPORT ON THE ADVERSE REACTION OR LACK OF THERAPEUTIC EFFECT OF A MEDICINE

Отправка формы…

На сервере произошла ошибка.

Форма получена.

Patient’s Data

MEDICINES ALLEGEDLY EVOKING THE ADVERSE REACTION (ADR)

Adverse Reaction

Other medicines administrated during 3 recent months, including those administered by the patient on his/her own (on his/her own free will)