INFORMATION ABOUT THE REPORTER





INFORMATION ABOUT THE PERSON WHO EXPERIENCED THE ADVERSE DRUG REACTION



ADVERSE DRUG REACTION INFORMATION

SUSPECTED DRUG INFORMATION












CONCOMITANT DRUGS AND MEDICAL HISTORY

Bionika Pharmaceuticals uses the information you provide on this form to give you information about your report of adverse drug reactions. We don’t keep any personal information about you. We only keep general information about adverse drug reactions. By clicking you agree that we may process your information in accordance with these terms.

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