Adverse Event Reporting

Creating Higher benchmark for Humankind, Since 1995

Creating Higher benchmark for Humankind, Since 1995

Creating Higher Benchmark for HumanKind, Since 1995

Name of SARP drug *

Batch No. *

Expiry Date *

Nature of event *

Name of Patient *

Sex *

Age *

Current status of Patient *

Description of Patient ADR/Condition *

Past Medical History *

Reporter's Name *

Mobile No. *

Are you the patient? *

Address *

Email *

Relationship to the Patient *

Name

If you would like to report us by post, please download event form & mail it to following address:

SARP PHARMACEUTICALS

Global Pharmacovigilance Dept.

Gandhi Setu Colony, South Bajrangpuri,

Patna-800007, INDIA

Phone: +918809292770, Email: adr.report@sarp.ltd

FAQ.

1. Who can report ?

Ans: Any Healthcare (doctor,nurses,pharmacist) / Non-healthcare professional (patient,relative/neighbor)

For any other queries, please contact us.

Please correct errors before submitting this form.