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For a consumer of a drug

*fields with an asterisk are mandatory

1. Report of a suspected ADR or LOE of a drug

Gender*

2. Information about the suspected drug

Maximum number of files - 10. Maximum file size - 10Mb.Acceptable extensions:(*.jpg,*.gif,*.png,*.doc,*.docx,*.xls,*.xlsx,*.pdf)

3. Information regarding the company’s privacy policy