map-message
on adverse reactions (PR) and / or lack of efficacy (OE)
medicinal product (medicinal product) during its medical application

The key task of Biopharma is to provide consumers with effective and safe medicines. Therefore, we will be grateful for providing reliable information on the detection of adverse effects or the lack of efficiency of our products. This will help us to improve the Biopharma drugs.

01. General information



Sex * MaleFemale



description of AR/ indicate LE of the MP

(including data on laboratory and instrumental studies related to AR)

Consequences of AR/LE RecoveryRecoveringNo changeUnknownRecovery with consequencesDeath not due to ARDeath, possibly due to ARDeath due to AR
AR/LE category Patient deathLife threateningгOutpatient hospitalizationProlongation of hospitalizationlong-term disability, invalidityCongenital malformationsAnother important medical evaluationNone of the above

02. Suspected drug information (SDI)








03. Information about concurrent drugs







04. AR correction measures

Was suspected drug cancellation accompanied by the termination of AR?

yesno


Increase/decrease, indicate increment

Is there a recurrance of AR after re-appointment of the suspected drug?

yesno

Is there a recurrance of AR after сhange of suspected drug dosage?

yesno

AR/LE Correction of AR/Le was not conductedDrug treatment of AR/LE

Specify the drug, dose regimen, duration of appointment

05. Reporter information


Consequences of AR/LE PhysicianPharmaceutistQualified Pharmaceutical ChemistNurseBiopharma employeeother