Adverse Drug Reaction(Anyone)

Report drug reaction of any medicine cosmetics or medical device you used.

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Reporter

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Patient

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Reaction

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Medicine

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Herbal

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Documents

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Outcome

Reporter Information


Add Patient Information


# Other Information

Suspected Reaction


Add medicine, cosmetic or medical device information


# Name Type Where you get Dosage How often per day How it was used Date started Reason for use

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Herbal Medicine Information


Have you ever used herbal medicine during the reaction ?

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Case Outcome


Reaction subsided after stopping the suspected drug / reducing the dose
Reappeared after reintroducing suspected drug
Do you consider the reaction to be serious
Treatment of adverse reaction / event

Outcome: