Lotuspharm Manufacturing Pvt Ltd

Important

This form is intended for reporting suspected adverse reactions and other safety information related to medicinal products.

This form is not intended for emergency medical assistance and does not replace consultation with a healthcare professional.

If the patient requires urgent medical attention, contact the appropriate emergency service or a healthcare professional.

Report an Adverse Reaction

Lotuspharm Manufacturing Pvt. Ltd. is a marketing authorisation holder for medicinal products and performs pharmacovigilance activities for those products.

If you believe that you or someone in your care experienced an adverse reaction while using a medicinal product for which Lotuspharm Manufacturing Pvt. Ltd. is the marketing authorisation holder, please report it using the form below.

Provide as much information as possible. Do not delay reporting because some details are unavailable. Report the reaction even if you are unsure whether it was caused by the medicinal product.

You do not need to have all requested information. Provide everything known to you when completing the form.

If additional information is needed to assess the report, a Lotuspharm Manufacturing Pvt. Ltd. pharmacovigilance specialist may contact you using the details provided.

Report type
Information about the person reporting the reaction

Provide information that allows you to be identified as the reporter. Do not provide passport data or other government identifiers.

To submit, provide at least one working contact method: email or telephone.

Patient information

Do not provide a passport number, national identification number or full medical record number.

For example: A.B., the patient’s child, the reporter’s mother, etc.

Suspected medicinal product

Enter the INN or the medicinal product name. At least one of these fields is required.

Adverse reaction information

Did any of the following consequences occur?

Select all that apply. The final medical assessment will be performed by Lotuspharm Manufacturing Pvt. Ltd. pharmacovigilance specialists.

Reaction outcome

Additional situation information

Select if the report is related to one or more of the following situations.

Other medicinal products

List other medicinal products taken during the reaction period, if known.

Medical information
Attach documents

If available, attach medical documents, packaging photographs or other relevant information. Do not attach documents containing excessive identifying personal data unless necessary.

JPG, JPEG, PNG or PDF. Maximum 5 MB per file and 6 files per report.

Fields marked * are required.