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.