Adverse - Global

QUERY FORM

For product complaints or reporting on adverse events, please call us on below number or send the details at below email id.

    QUERY FORM

    For product complaints or reporting on adverse events, please send the details at below email id.

    globaldrugsafety@akums.in

    Confidentiality: The patient's identity is held in strict confidence and protected to the fullest extent. The company shall not disclose the reporter’s identity in response to a request from the public.

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    PATIENT INFORMATION














    SUSPECTED ADVERSE REACTION










    SUSPECT DRUG INFORMATION

    S.No.

    Name
    (Brand
    Generic)*

    Batch No.
    Lot No.

    Dose
    Used

    Route
    Used

    Frequency
    (OD, BD etc.)

    Expiry
    date

    Therapy
    Start
    date

    Therapy
    End
    date

    Indication
    (Medicine
    used for)





    CONCOMITANT MEDICATION (S)








    RELEVANT MEDICAL HISTORY/LAB TESTS

    ADDITIONAL SUPPORTING DOCUMENTS

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    If you would like to send us information via e-mail, Please download the ADR form below and mail it to globaldrugsafety@akums.in

    Download Adverse Event Reporting Form

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