Pharmacovigilance Form

Arabian Ethicals Pharmacovigilance Form

Using this form healthcare professionals can report any suspected Adverse Reaction (AR), Medication Error (ME) and Adverse Event experienced from any of the drug product within the stipulated timeframe as defined in DoH policies, even if reporters are not certain that the particular medicinal product was the cause.

Unintended adverse effects, drug abuse, overdose, interaction (including drug-drug and drug-food interactions) and unusual lack of therapeutic efficacy are all considered to be reportable suspected Adverse Reactions (AR).

To establish long-lasting partnerships with healthcare corporations, institutions and professionals.

A. Patient Details (See Confidentiality section)
B. Medical products used
C. Adverse Reaction
D. Outcome of Adverse Reaction
E. Seriousness of Adverse Reaction *
F. If this is a follow up report of an already reported AR case, please tick this box
G. Reporter Details

Any information related to the identity of the patient and / or the reporter of the adverse reaction will be protected to the fullest extent of law and will not be used in anyway against him/her.