Adverse Event Reporting

How to Report Adverse Events

In order for us to monitor and assess the ongoing safety of our products, we encourage patients and healthcare professionals to report suspected adverse events”

“Adverse effects” or “Adverse events” refer to the unintended or undesirable events subsequent to use of a medicine.

If you believe you have experienced a side effect from one of our medicines, please take the following actions:

Contact your doctor, pharmacist or nurse who can then notify Pharmax
Pharmax can be contacted through the following channels

Filling and submitting the below online form

By Phone : +971 4 2486515

By email : medicines.info@pharmax.ae

Download as pdf

How to Report Adverse Events

Date of Event

Event Date*

Reporter Details

Full Name*

Email ID*

Phone*

Address

Patient Information

Full Name

Email ID*

Gender*

Age/Date of Birth*

Weight

Telephone*

Address

Adverse Drug Reaction

Description of Event*

Start Date of Reaction*

End Date of Reaction

Is the ADR serious?*

If YES REASON FOR SERIOUSNESS

If YES REASON FOR SERIOUSNESS

Suspected Medication

Drug Name*

Generic Name*

Strength

Batch No

Mfg Date

Expiry Date

Daily Dose

Indication

Start Date*

Stop Date

Concomitant Medication (S)

Drug Name

Generic Name

Daily Dose

Indication

Start Date

Stop Date

Action taken to Treat ADR

Did the ADR subside after stopping the suspected medication

Medical History

Condition

Onset

Details

Present

Outcome of the Adverse Reaction

Pharmacy/Hospital Name

Pharmacy

Hospital

Name of Healthcare Professional*

Signature*

Date*

Additional Information