Life At NOVO

Report Adverse Event

Reporter Details/ (रिपोर्टर विवरण)

All fields marked with * are mandatory

Your Name*

Occupation

Email Address*

Telephone*

Apartment/House/Plot Number

Street Name

Landmark

Pin code*

Country*

State*

City*

If reporter is the patient/ (अगर रिपोर्टर मरीज है):

Suspect Drug Details/ (संदिग्ध दवा विवरण)

Name of Drug*

Batch No.*

Expiry Date*

Dose

Frequency

Start Date

End Date

Adverse Event Details/ (प्रतिकूल घटना विवरण)

Description of event/ (घटना का विवरण)*

Intensity/ (तीव्रता)

Note:

Fields marked ** are mandatory and needs to be filled before submitting.
You may also send us Adverse Event Information by filling the below forms and sending the same to the address mentioned below (Address in Footer)

Contact:

drugsafety@novomedi.com

1800 - 309 - 0896