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Pharmacovigilance
Kusum Healthcare Pvt Ltd

We have created and are constantly improving the pharmacovigilance system in order to ensure the safety and efficacy of drugs produced by Kusum Group of Companies.
If the use of drugs has resulted in a case of an adverse reaction and/or lack of efficacy (hereinafter referred to as AR/LE), please contact your doctor immediately*.

Fill in the message card presented below to inform about the occurrence of AR and/or LE in the case of medical use of medicines produced by Kusum Group of Companies.

The information provided can be used solely for tracking, analysing and reporting on the safety of self-produced medicines.

We guarantee that no appeal will be left unattended and will be carefully considered.

FILL IN THE QUESTIONNAIRE "LACK OF EFFICACY OF KP MEDICINES"
DOWNLOAD THE QUESTIONNAIRE "LACK OF EFFICACY OF KP MEDICINES"
FILL IN THE QUESTIONNAIRE "ADVERSE REACTIONS OF KP MEDICINES"
DOWNLOAD THE QUESTIONNAIRE "ADVERSE REACTIONS OF KP MEDICINES"
* To give the information regarding the above cases, as well as for advice on these issues, please contact the Pharmacovigilance Department of Kusum Group of Companies.
Kusum Healthcare Pvt Ltd
Regd. Office:
P.O. Box 22, Kyiv 02092, Ukraine
Tel:
(044) 4958287; (067) 4340378;
Fax:
(044) 4958287;
Email:
[email protected]
Go to Website
All information that you provide to us is confidential and not subject to disclosure, except as provided by law.
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Online application form

*These fields are required.

INFORMATION ABOUT A PATIENT
Patient initials (only first letters):
Patient initials
Sex:
Day of birth
Year of birth
Weight (kg)
Height (sm)
Hepatic disease:
Renal disease:
Pregnancy:
Term
Allergy:
SUSPECTED PHARMACEUTICAL PRODUCT(-S) (SPP)
Brand name
International non-proprietary name
Pharmaceutical form
Batch No
Start date (dd/mm/yyyy)
End date (dd/mm/yyyy)
Dosage, frequency and method of administration ...
Prescribed for...
Add another appointment
OTHER PHARMACEUTICAL PRODUCTS (administered in the last 3 months)
Have you taken any other medicines in the last 3 months?
LACK OF EFFICACY (LOE)
Description of lack of efficacy signs (including any results of relevant supportive laboratory tests and other investigations) .
Start date of LOE (dd/mm/yyyy)
End date of LOE (dd/mm/yyyy)
Did changing of SPP result in LOE disappearance?:
Did rechallenge of SPP cause repeated LOE?:
Measures taken:
Specify the name
Pharmacological therapy of LOE (if any):
Text...
Result:
Indicate recovery with consequences
Measures of the seriousness:
Specify
INFORMATION ABOUT A REPORTER
Full name
Phone
Occupation
Health care institution
Address
Email
Date of LOE information receipt
Filling date (dd / mm / yyyy)
Online application form

*These fields are required.

INFORMATION ABOUT A PATIENT
Patient initials (only first letters):
Patient initials
Sex:
Day of birth
Year of birth
Weight (kg)
Height (sm)
Hepatic disease:
Renal disease:
Pregnancy:
Term
Allergy:
SUSPECTED PHARMACEUTICAL PRODUCT(-S) (SPP)
Brand name
International non-proprietary name
Pharmaceutical form
Batch No
Start date (dd/mm/yyyy)
End date (dd/mm/yyyy)
Dosage, frequency and method of administration ...
Prescribed for...
Add another appointment
OTHER PHARMACEUTICAL PRODUCTS (administered in the last 3 months)
Have you taken any other medicines in the last 3 months?
SUSPECTED ADVERSE DRUG REACTION(-S) (ADR)
Description of the ADR (including any results of relevant supportive laboratory tests and other investigations) .
Start date of ADR (dd/mm/yyyy)
End date of ADR (dd/mm/yyyy)
Did the ADR disappear after the drug was discontinued?:
Did rechallenge of SPP cause repeated ADR?:
Measures taken:
Specify the name
Pharmacological therapy of ADR (if any):
Text...
Result:
Indicate recovery with consequences
Measures of the seriousness:
Specify
INFORMATION ABOUT A REPORTER
Full name
Phone
Occupation
Health care institution
Address
Email
Date of LOE information receipt
Filling date (dd / mm / yyyy)
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