Pharmacovigilance

Protecting your health

Suspected Adverse Drug Reaction (SADR) Report.

General Public

General
Data of the Patient, user or consumer

Symptoms

Who reports?

General
Data

Country from which you report*

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Full Name or Initials (starting with last names)*

* This field is required

Date Of Birth

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Assigned sex at birth*

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Weight (kg)

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Size (cm)

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Name of symptom*

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Did you recover from your symptoms?

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When did the symptoms begin?

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Name of the product which you believe to have caused the symptoms*

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How long have you been taking this medication?

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Select a period indicating start date and end date.

Did you discontinue the treatment? *

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Who recommended you this medication?

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Are you taking any other medication at the same time as the reported product?

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Which on?

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Who reports?

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Do you want to be contacted by Pharmacovigilance?*

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Landline

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Cellphone number

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E-mail

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Comments

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Thank you for having completed our Pharmacovigilance form, shortly our specialists will contact you if requested.

If you prefer, you can call the number: 800 -Sanfer1 (800 726 3371), 24 hours a day, or write to the following e-mail: ucfarmacovigilancia@sanfer.com.mx

Pharmacovigilance

Protecting your health

Suspected Adverse Drug Reaction (SADR) Report.

General Public

General Data of the Patient, user or consumer

Symptoms

Who reports?

General Data

Select a period indicating start date and end date.

Thank you for having completed our Pharmacovigilance form, shortly our specialists will contact you if requested.

If you prefer, you can call the number: 800 -Sanfer1 (800 726 3371), 24 hours a day, or write to the following e-mail: ucfarmacovigilancia@sanfer.com.mx

General
Data of the Patient, user or consumer

General
Data