ZFDA Pharmacovigilance Electronic Reporting System (PERS)
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productDescription
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fullName
*
email (optional)
phone
*
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*
selectIsland
Unguja
Pemba
region
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selectRegion
district
*
selectDistrict
ward
*
street
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brandName
*
genericName
*
batchNumber
*
country
*
countryPlaceholder
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Virgin Islands, U.S.
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manufactureDate (optional)
expireDate (optional)
formulationName
*
capsule
syrup
injection
cream
powderSuspension
powderInjection
eye
ear
nebulizer
diluent
supplierName (optional)
supplierAddress (optional)
productLocation (optional)
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color
turbid
odour
caking
separating
moulding
powdering
pack
mislabeling
other
complaintDescription
*
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uploadProductDocument
documentSample
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storageCondition
is_stored
no
yes
is_available
no
yes
is_returned
no
yes
is_require_refrigeration
no
yes
other
comment (ifAny)
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