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    Drug-related adverse events represent an alarming problem that must be addressed by health care practitioners. Adverse drug reactions are responsible for a significant number of hospital admissions, with reported ranges from 0.3% to as high as 7%. Some have estimated that up to 15% of hospitalized patients suffer at least one adverse drug reaction during their hospital stays.

    This prospective system benefit the patients who experience a reaction because they are recognized earlier and future patients benefit from information learned from past patients. Other benefits could include the economic Impact Of Reduced Hospitalization, Efficient And Economical Drug Use, and Minimized Organizational Liability.

    Hence we request you fill up the ADR form if such adverse drug reaction occurs during the course of therapy. Contact the center for more details.

 

All Drug Therapy Prior to Reaction Asterisk Suspected Drugs

Daily Dosage
and Route

Begin
Date
Stopped
Date
Reason for
use
Name
or Record
Age :
Height :
Sex :
Weight :
Date of onset of Reaction :
Adverse Reaction Description:
Recovered :
Date of Recovery :
 
Not yet Recovered :
Unknown :
 
Fatal :
Date of   Death :
yes :
No:
     
 
Comments (e.g. Relevant history, allergies, previous exposure to this drug)
Name :
*
Address:
E-mail :
*
 

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