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CI OMS FORMDEBFARM17273260SUSPECT ADVERSE REACTION REPORT I. REACTION INFORMATION 1. PATIENT INITIALS1a. COUNTRYDEprivacy2. DATE OF BIRTH DA MO YR2a. AGE3. SEX66 (Year)Male46 REACTION ONSET DA MO
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How to fill out cioms report cioms report

01
Gather all necessary information and documentation required to fill out the CIOMS report.
02
Start by providing the basic details such as the date of the report, the name of the reporter, and contact information.
03
Identify the suspected medicinal product or device and provide specific details such as the brand name, the dosage form, and the batch or lot number.
04
Describe in detail the adverse reaction or event that occurred, including the date and time of onset, the duration, and any relevant medical treatment provided.
05
Provide information about the patient experiencing the adverse reaction, including age, gender, weight, and relevant medical history.
06
Include any concomitant medication or treatment that the patient was undergoing at the time of the adverse event.
07
Provide information about the reporter's qualifications and relationship to the patient, such as being a healthcare professional or a family member.
08
Summarize the outcome of the adverse event, including any recovery or ongoing consequences.
09
Attach any supporting documents or laboratory reports that may be relevant to the adverse event.
10
Review the completed CIOMS report for accuracy and completeness before submission.

Who needs cioms report cioms report?

01
Pharmaceutical companies that manufacture and distribute medicinal products or devices.
02
Regulatory agencies responsible for monitoring and evaluating the safety of medicinal products and devices.
03
Healthcare professionals who encounter adverse reactions or events in their patients and need to report them.
04
Researchers and academic institutions conducting studies on the safety and efficacy of medicinal products or devices.
05
Patients or their caregivers who wish to report an adverse reaction or event directly to the relevant authorities.
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CIOMS report is a form used to report serious and unexpected adverse reactions to medical products.
Healthcare professionals and drug manufacturers are required to file CIOMS report.
CIOMS report should be filled out by providing information about the patient, the suspected product, the adverse reaction, and any other relevant details.
The purpose of CIOMS report is to monitor and track adverse reactions to medical products in order to ensure patient safety.
Information such as patient details, suspected product details, adverse reaction details, and any other relevant information must be reported on CIOMS report.
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