info@radiantpharma.com
hr@radiantpharma.com
DML License No.
000776
Home
About Us
Product
Business Development
Manufacturing Facility
Careers
News and Updates
Quality
Company Policies
Quality Policy
Certificate
Pharmacovigilance
Drug Safety
Report ADR Online
R & D
Home
About Us
Product
Business Development
Manufacturing Facility
Careers
News and Updates
Quality
Company Policies
Quality Policy
Certificate
Pharmacovigilance
Drug Safety
Report ADR Online
R & D
Adverse Event Reporting Form
Patient Information
Patient Name/Initial
Contact Number
Gender
---
Male
Female
Age
Details Of The Side Effects
Reaction onset Date:
Reaction Detail: Describe the event (e.g. Diarrhoea, Vomiting, Headache, Bleeding etc)
Medicine Prescribed By:
Dr. Name:
Cell No:
Radiant Pharma Product Name:
Daily Dose:
Start Date:
Stop Date:
Frequency:
Batch#:
Reporters Particulars
Reporter Name:
City:
Contact No:
Email:
Profession:
Doctor
Nurse
Pharmacist
Patient
Other
