Get Adverse Event Reporting Form

Filling out the Adverse Event Reporting Form is an essential step in reporting important safety information regarding medical products. This guide provides straightforward, step-by-step instructions to help you accurately complete the form online.

Follow the steps to effectively complete the Adverse Event Reporting Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient details. Fill in the patient's initials, age in years or months, weight in kilograms or pounds, sex, and date of birth in the specified format (DD/MM/YYYY). Also, indicate if the patient is pregnant and any relevant medical history that could include pre-existing conditions.
3. In the ADR details section, provide the term(s) for the adverse drug reaction. Enter the dates when the reactions started and stopped, and describe the adverse events in detail, including signs, symptoms, diagnosis, treatment, and actions taken. Include any relevant outcomes, such as hospitalization details or the need for intervention.
4. Fill out the drug details section. List the drug's brand and/or generic name, the manufacturer if known, batch number, expiration date (if known), dosage, route, frequency, and therapy dates. Indicate the reason for the drug's use and whether the reaction abated or reappeared after stopping the drug or reducing the dose.
5. Provide information on any concomitant medical products, including herbal remedies, that were used during the therapy dates, and exclude those that were used specifically to treat the reaction.
6. Complete the reporter details section by entering your name, address, pin code, email, and occupation. Then sign the form.
7. Before submitting, confirm that all provided information is accurate. Review the report type, whether it is an initial or follow-up report, and include your contact number.
8. Once completed, save your changes, and you can choose to download, print, or share the form as required.

Take the necessary steps to report adverse events online by completing the form now.