ADRM Entry Form

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DGDA-RIMS for Vaccine/Biosimilar product online regestration.

Piloting of Online Adverse Event Reporting tools (PViMS).

Five-Year Strategic Plan (2022-2026)

Pharmacovigilance Protocol for Covid-19 vaccines

Suspected Adverse Event Reporting Form

Identities of reporter, patient, institution, and product trade name(s) will remain confidential

ADR
REPORT

A. PATIENT
AND HOSPITAL
INFORMATION
B. SUSPECTED
ADVERSE
EVENT
INFORMATION C. OTHER
CONCOMITANT
PRODUCT
INFORMATION D. REPORTER
INFORMATION

Product #

Brand name*

Generic name*

Indication*

Dosage form

Route

Dose

Frequency

Date started

Date stopped

Add Product 1

Add Product 2

Add Product 3

Add Product 4

Sl	Brand Name	Generic Name	Strength	Dosage	Brand Id	Generic Id	Strength Id	Dosage Id

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© 2021 All rights reserved for Directorate General of Drug Administration.

Aushad Bhavan, Mohakhali, Dhaka-1212, Bangladesh

Tel : 8802 9880803, 9880864, 9880897, 9880924, Fax : 8802 9880854, E-mail : dgda.gov@gmail.com

Display Date and Time

10/06/2023

Last Modified: Wednesday 17 May 2023, 13:56:26.