CyH Lab Home Pharmacovigilance PHARMACOVIGILANCE Por favor, activa JavaScript en tu navegador para completar este formulario.Por favor, activa JavaScript en tu navegador para completar este formulario.DateName *NombreApellidosProfessionInstitution/ClientEmail *Phone *Name (of the patient) *NombreApellidosAgeMedication (cause of report)Date treatment startedDate treatment endedDosageRelationship with other concomitant medicationsMedication 1 include: -Date treatment started -Date treatment ended -DosageMedication 2include: -Date treatment started -Date treatment ended -DosageMedication 3include: -Date treatment started -Date treatment ended -DosageDescription of the adverse drug reactionCommentsSend
