QUERY FORM

    For product complaints or reporting on adverse events, please call us on below number or send the details at below email id.

    AKUMS INDIA

    Toll free number- 1800-313-3363, Mail Us: indiadrugsafety@akums.in
    All working days (Monday to Saturday) 9:00 AM to 6:00 PM

    Confidentiality: The patient's identity is held in strict confidence and protected to the fullest extent. The company shall not disclose the reporter’s identity in response to a request from the public.

    All asterisk (*) fields are mandatory to fill

    PATIENT INFORMATION













    SUSPECTED ADVERSE REACTION










    SUSPECT DRUG INFORMATION

    S.No.

    Name
    (Brand/Generic)*

    Batch No. / Lot No.

    Dose Used

    Route Used

    Frequency(OD, BD etc.)

    Expiry date

    Therapy Start date

    Therapy End date

    Indication
    (Medicine used for)





    CONCOMITANT MEDICATION (S)








    RELEVANT MEDICAL HISTORY/LAB TESTS

    ADDITIONAL SUPPORTING DOCUMENTS

    If you would like to send us information via e-mail, Please download the ADR form below and mail it to indiadrugsafety@akums.in

    Download Adverse Event Reporting Form / प्रतिकूल घटना रिपोर्टिंग फॉर्म डाउनलोड करें