Adverse event

To report about the adverse event

Pharmasyntez cares about the medicines and consumers health.

Following ethical principles and requirements of the Russian legislation, we perform collection and the analysis of information on by-effects and interaction of drugs and also actively cooperate with regulatory organizations in this area.

If you faced the adverse event which arose in the course of Pharmasyntez medicines use, please, fill a special electronic form on the website, or call in Service of Pharmacovigilance at the Moscow Pharmasyntez office by phone: +7 (3952) 550-355.

If you want to get advice on medicines quality, we kindly ask you to fill up and to send back the Quality Questionnaire.

PATIENT INFORMATION

Name and surname*

Age*

Sex*

MaleFemale

Region

Information on the suspected medicine

Name of the medicine*

Presentation*

Manufacturer

DISEASE FOR WHICH TREATMENT/PREVENTION THE DRUG * WAS TAKEN*

Start date of drug administration*

Date of the termination

Start date of the adverse event*

End date of the adverse event

DESCRIPTION OF THE adverse event (SYMPTOMS, RESULTS OF LABORATORY RESEARCHES)*

Attachment

INFORMATION ON THE SENDER

INFORMATION ON THE SENDER*

FULL NAME

PREFERABLE METHOD OF FEEDBACK*

PROTECTION AGAINST AUTOMATIC FILLING

CAPTCHA*

* — Required fields