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Welcome to the Adverse Event Report page

If you or you become aware that other patients have experienced or are experiencing adverse events after using Baoji products, you should promptly seek advice from healthcare professionals and fill out the adverse event report form according to the following steps

Your Name *

Your profession *

Please choose

Your unit (if you are a medical staff)

Your phone number *

Your email address *

Do you accept follow -up

Yes
No
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Your Name

Your gender *

Please choose

Date of birth

Your phone number

Your nationality

Nation/race

Weight (kg)

Height (CM)

Original disease

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Doubt the name of the medicine *

Pharmaceutical listing license holder*

Production batch

Usage frequency

Dose every time

Drug start date *

Measures to take Baoji Pharmaceutical products

Please choose

The end date of the medication (still not filled in still)

Other medicines used at the same time

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Adverse Reaction Term *

Adverse Reaction Onset Date *

Outcome *

Please select

Adverse Reaction Resolution Date

Causality Assessment *

Please select

Adverse Reaction Description (Provide details including patient info, allergy history, medication details, diagnosis & treatment, lab results, and actions taken. Include pregnancy/lactation status if applicable) *

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Other information (you can insert the patient's medical records, check reports, etc. here)

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