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Adverse Event Reporting

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Suspected Adverse Drug Event (AE) Report Form

Patient Information ?
(e.g., child, elderly)
Event Description ?
Drug Use Detail ?
* Suspect Drug details(Unit dose/strength & Form)   Indication   Dosage/ Unit/ Frequency   Route
1.
 
 
 
2.
 
 
 
Treatment Dates
* Start Date   End (or Ongoing)   Lot/Batch #   Expiration Date
1.
 
 
 
2.
 
 
 
Reporter Information
Please answer the simple math problem below. This is to prevent automated spam.
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If you would like to send us information by post, please download the form here and mail to the following address:

 

Global Pharmacovigilance Department
Sun Pharmaceutical Industries Ltd.
SUN HOUSE,CTS No. 201 B/1,
Western Express Highway,
Goregaon (E),
Mumbai 400063
Tel :(+91 22) 4324 4324

Fax No. +91-22-66455699
E-Mail: drugsafety@sunpharma.com