Adverse Drug Reaction Reporting Form

1. Patient Details:

2. Describe the Side effect(s)

How bad was this side effect? (You can chose more than one)

3. Suspected Medication Information

4. Concomitant Medications (any other Medication that the patient is taking) and Medical History (any chronic diseases that the patient has )
5. Reporter’s Information:
Coil Weight

1. Patient Details:

2. Describe the Side effect(s)

How bad was this side effect? (You can chose more than one)

3. Suspected Medication Information

4. Concomitant Medications (any other Medication that the patient is taking) and Medical History (any chronic diseases that the patient has )
5. Reporter’s Information:
Coil Weight
Mohammed Mahdi Al-Shaer Corporation is run by skilled leaders who have extensive knowledge and expertise within the healthcare industry with a strong capability to successfully launch and commercialize pharmaceutical products.
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