A. Patient Information*

    B. Medication Details*

    C. Suspected Adverse Drug Reaction*

    D. Action taken after adverse reaction

    E. Seriousness of the reaction

    F. Outcome of reaction

    G. Reporter Details

    If you would like to send us information by post, please download the form and mail to the following address:

    Technical Department

    Meridian Enterprises Pvt. Ltd

    1108, Embassy Centre, Nariman Point,

    Mumbai - 400 021, India.

    Telephone No. (+91 22) 66084200