Follow the steps to complete the form online with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the ‘A. Reporter Information’ section. This includes specifying the report source, entering the reporter qualification, and providing contact information for the market authorization holder or source establishment.
3. Fill out the ‘C. Adverse Reaction’ section. Indicate the date and country where the reaction occurred, describe the reaction in detail, and check the relevant seriousness criteria.
4. Provide ‘B. Patient Information’. Include the unique identifier, patient age, sex, height, and weight at the time of the reaction.
5. In the ‘D. Health Product(s)’ section, list up to two suspected health products and provide necessary details such as product name, strength, dosage form, and indication for use. Indicate therapy dates and any relevant lot numbers and expiry dates.
6. Document any concomitant health products and the treatment administered for the adverse reaction, ensuring all fields are filled accurately.
7. After completing the form, save changes, and choose whether to download, print, or share the form as necessary.

Complete the Canada Mandatory Adverse Reaction Reporting Form online today!