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Report problems associated with the use of the drug
You can fill out an electronic adverse reaction/lack of therapeutic efficacy report form.
A healthcare or pharmaceutical professional reporting an adverse reaction
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Treatment
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Message
Patient information
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Specify the gender of the patient
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Impaired liver function
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Impaired renal function
Suspected drug
Other medications taken at the same time
Indicate "no" if no other medication was taken
Result of discontinuing the suspected drug
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Assessing causation
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Exodus
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Measures taken
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Criteria for classifying as serious adverse reactions (check the box if it fits)
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Whether a recurrence of an adverse reaction has been noted after a second prescription of the medication
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The suspected drug is used in
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Important additional information
Clinical, laboratory, radiological, and autopsy findings, including blood (tissue) drug concentrations, if any, associated with an adverse reaction (please provide dates)
For congenital abnormalities, list all other medications taken during pregnancy and the date of the last menstruation (indicate "no" if no such medications exist)