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NDH Pharmacovigilance Center for Public Health Programs (NPC) Adverse Drug Reaction (ADR) / Product Quality Problem Report Form This report will be shared with the South African Health Products Authority

How to fill out adverse drug event form

How to fill out adverse drug event form

1. Gather all relevant information about the adverse drug event, including the patient's details, the drug name, dose, and frequency, and the symptoms experienced
2. Fill out the patient demographics section with the patient's name, date of birth, gender, and contact information
3. Provide details about the drug involved, including the name, dosage, frequency, route of administration, and start and stop dates
4. Describe the adverse event experienced by the patient, including the symptoms, onset date, severity, and any actions taken in response
5. Include any relevant medical history or concomitant medications being taken by the patient
6. Sign and date the form to attest to the accuracy of the information provided

Who needs adverse drug event form?

1. Healthcare professionals such as doctors, nurses, and pharmacists who have observed or been informed about an adverse drug event
2. Regulatory authorities who require reports on adverse drug events for monitoring and evaluation purposes

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What is adverse drug event form?

Adverse drug event form is a document used to report any negative reactions or side effects experienced from taking medication.

Who is required to file adverse drug event form?

Healthcare professionals, patients, and drug manufacturers are required to file adverse drug event forms.

How to fill out adverse drug event form?

Adverse drug event forms can be filled out online or in paper form, providing specific details about the reaction, the drug involved, and any other relevant information.

What is the purpose of adverse drug event form?

The purpose of adverse drug event form is to track and document any negative reactions to medications, helping ensure patient safety and drug efficacy.

What information must be reported on adverse drug event form?

The adverse drug event form must include details about the patient, the medication, the reaction experienced, and any other relevant information.