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Pharmacovigilance

We have created and are constantly improving the pharmacovigilance system to guarantee the safety and efficacy of medicines produced by the companies KUSUM PHARM LLC, Ukraine or Kusum Healthcare Pvt Ltd, India.

If administration of medicines has resulted in occurrence of an adverse reaction (AR) and/or lack of efficacy (LE), seek medical help immediately.

Fill in the report form to inform us about the occurrence of AR and/or LE during the use of medicines produced by the companies KUSUM PHARM LLC, Ukraine or Kusum Healthcare Pvt Ltd, India.

If necessary, the information provided will be used solely for tracking, analysis and reporting on the safety and efficacy of medicines produced by our company.

We guarantee that every appeal will be carefully considered. If you have any questions related to the safety and efficacy of using the medicines, contact the pharmacovigilance department.

You can also read information letters for healthcare professionals and/or patients (in Ukrainian) about important aspects related to the safety of certain medicines.

FILL IN THE REPORT FORM “LACK OF EFFICACY OF MEDICINES”
DOWNLOAD THE REPORT FORM “LACK OF EFFICACY OF MEDICINES”
FILL IN THE REPORT FORM “ADVERSE REACTIONS OF MEDICINES”
DOWNLOAD THE REPORT FORM “ADVERSE REACTIONS OF MEDICINES”
Kusum Healthcare Pvt Ltd
Regd. Office:
58, Alma-Atynska str., Kyiv, 02092
Tel:
(044) 4958287;
Email:
[email protected]

Contact details of the qualified person responsible

for pharmacovigilance:

Pryzymyrska Tamara

mob. phone: +38(067) 434-03-78

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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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