NOTIFICATION FORMAT
    OF ADVERSE EVENTS

    SELECT AN OPTION, ACCORDING TO THE NATURE OF THE REPORT

    1. PRIMARY NOTIFIER INFORMATION

    2. ORIGIN OF THE REPORT

    3. INFORMATION OF THE PATIENTE

    4. MEDICATION ADVERSE EVENT INFORMATION

    Evolution (Select one of the following options)

    Seriousness (Select one or more of the following options)

    5. MEDICATION INFORMATION - Record all medications used and select those suspects in column S

    6. COMMERCIAL INFORMATION OF THE SUSPECTED MEDICINAL PRODUCT

    7. MANAGEMENT OF THE EVENT AND UNLINK

    8. EVENT ANALYSIS

    GENERAL RECOMMENDATIONS FOR NOTIFICATION

    REPORT ALL SUSPECTED ADVERSE EVENT TO MEDICATION: Notify even if the event is expected, mild or not serious. In the same way, notify the events related to possible medication errors (prescription, dispensing, preparation, administration, adherence).

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