Please use this section to complete report form and send online notification of adverse drug reaction, a report of lack of therapeutic efficacy or a product quality complaint, or use attached file and send completed form to adverse@drreddys.com or by fax: +7 495 795-39-08.

In addition, you can contact us by phone on +7 495 795-39-39 and submit adverse drug reaction, report of lack of therapeutic efficacy or product quality complaint.

We strongly urge you to indicate your contact data in order to allow us to request additional information or to answer you.

Information for Professionals

Pharmacovigilance Form

HEALTHCARE PROFESSIONAL / REPORTER
Outpatient
Inpatient
Self-treatment
Primary
Secondary
Patient Data
M
F

Yes
No
Unknown
Yes
No
Unknown
MEDICINAL PRODUCT No. 1 presumably caused ADR












MEDICINAL PRODUCT No. 2 presumably caused ADR












MEDICINAL PRODUCT No. 3 presumably caused ADR












Other drugs taken during the last 3 months, including medicines taken by the patient himself (in its sole discretion)




























































Did the event resolve after stopping drug?



Yes

No

Didn't stopped

Not applicable

Did the ADR reappear after reintroduction?



Yes

No

Didn't reintroduced

Not applicable

Measures taken



Without treatment

Stopping the concomitant drug

Stopping the suspect drug

Drug treatment

Dose reduction of the suspect drug

Non-drug treatment (including surgery)

Other, specify

Drug therapy of ADR (if required)

Outcome



Recovery without consequences

Recovery with consequences

Condition Improved

Condition without changes

Death

Unknown

Not applicable

Criteria for seriousness (specify if applicable)



Death

Congenital malformations

Life-threatening condition

Incapacity / disability

Inpatient hospitalization or prolongation of existing hospitalization

Not applicable

Please confirm that you are not a robot