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PRODUCTS AND SERVICES
Product center Product branding Quality & Safety

Filling Instructions

  • 01. Please fill in the medicines you think are related to adverse reactions as suspected medicines (Please fill in the products belonging to Grand Pharma).
  • 02. Please fill in other medicines used in case of adverse reactions as combined medicines.
  • 03. The description of adverse reaction process shall include: what kind of medicine was used for what kind of disease, the taking time of medicines, the time and symptoms of adverse reactions, what measures are taken and whether the adverse reactions are cured or improved.
  • 04. Please fill in the same name if the reporter is the patient.
  • 05. The Company will store the information about patient and reporter in strict accordance with relevant regulations and ensure that relevant privacy will not be disclosed.
  • 06. Please fill in the form for over-dosing, off-label medication and other medication errors during the taking of medicines.
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Patient information

Items marked with * are required
  • * Full name:
  • Gender:

    Please select

  • * Age:
  • Weight (kg):
  • Other information (past medical history, allergy history, etc.):

Medication information

Suspected medicine
  • * Medicine name:
  • * Batch No:
  • Manufacturer:
  • Diseases treated:
  • Time to start medication:
  • Time to cease the medication:
  • Usage and dosage:
  • Route of administration:
Combined medicine
  • * Medicine name:
  • * Batch No:
  • Manufacturer:
  • Disease treated:
  • Time to start medication:
  • Time to cease the medication:
  • Usage and dosage:
  • Route of administration:
  • * Description of adverse reaction process:
  • * Time of occurrence:

Information on reporter

  • * Full name:
  • * Contact information: