Pharmacovigilance

Pharmacovigilance

Pharmacovigilance (drug safety) refers to scientific research and activities aimed at detecting, evaluating, understanding, and preventing adverse reactions or any other issues related to the use of medicinal products.

Dear specialists and consumers of medicinal products!

If you have any information regarding adverse reactions or lack of effectiveness of medicinal products manufactured by Valartin Pharma LLC, we kindly ask you to fill out the relevant form on our website or provide the necessary information via the following phone numbers: 

+38(044) 454-72-92 (from 9:00 AM to 6:00 PM), 

+38(044) 454-72-97, fax (from 9:00 AM to 6:00 PM).

You can also contact the Authorized Person responsible for pharmacovigilance at Valartin Pharma LLC: 

+38(067) 553-20-58 - Olena Mykolaivna Davydova.

Once your report is received, our representative will promptly get in touch with you.

І. Reporter Information
Full Name of the contact person
E-mail *
Contact phone number *
ІІ. Patient Information
Full Name of the patient *
Year of birth or full age *
Gender *
Diagnosis *
Address
Phone/Fax *
ІІІ. Information about the suspected medicinal product
Name of the medicinal product *
Dosage form
Manufacturer
Was the suspected medicinal product prescribed by a doctor?
Did the patient use the suspected medicinal product without a doctor's prescription?
Description of the adverse reaction or indication of lack of effectiveness *
IV. Information about the doctor and the healthcare institution
Full Name of the doctor
Name of the healthcare institution
Location of the healthcare institution, phone/fax
І. General Information
Full Name of the patient *
Medical record/history number or outpatient card number
Date of birth *
Gender *
Onset of AR/IE (date)
Onset of AR/IE (time)
End of AR (date)
End of AR (time)
Description of AR/Indication of IE of the medicinal product * (Including laboratory and instrumental examination data related to the AR)
Outcome of AR/IE
Category of AR/IE
ІІ. Information about the suspected medicinal product
Name of the medicinal product * (Name of the medicinal product)
Manufacturer, country *
Batch number *
Diagnosis *
Single dose *
Frequency of administration *
Route of administration *
Start of suspected medicinal product therapy *
End of suspected medicinal product therapy *
ІІІ. Information about concomitant medicinal products (excluding those used to manage AR consequences)
Medicinal Product 1
Concomitant medicinal products (Trade name, dosage form, manufacturer)
Indications
Single dose
Frequency of administration
Route of administration
Start of therapy
End of therapy
Medicinal Product 2
Concomitant medicinal products (Trade name, dosage form, manufacturer)
Indications
Single dose
Frequency of administration
Route of administration
Start of therapy
End of therapy
Medicinal Product 3
Concomitant medicinal products (Trade name, dosage form, manufacturer)
Indications
Single dose
Frequency of administration
Route of administration
Start of therapy
End of therapy
Medicinal Product 4
Concomitant medicinal products (Trade name, dosage form, manufacturer)
Indications
Single dose
Frequency of administration
Route of administration
Start of therapy
End of therapy
Medicinal Product 5
Concomitant medicinal products (Trade name, dosage form, manufacturer)
Indications
Single dose
Frequency of administration
Route of administration
Start of therapy
End of therapy
Medicinal Product 6
Concomitant medicinal products (Trade name, dosage form, manufacturer)
Indications
Single dose
Frequency of administration
Route of administration
Start of therapy
End of therapy
Other Important Information (Diagnosis, allergies, pregnancy with term specification, etc.)
IV. AR Correction Measures
Withdrawal of the suspected medicinal product
Was the AR resolved after the withdrawal of the medicinal product?
Re-administration of the suspected medicinal product
Was the AR recurrence noted after re-administration of the medicinal product?
Change in the dosing regimen of the suspected medicinal product
Specify the reduction/increase and by how much
Was the recurrence of AR/IE noted after the change in dosing regimen?
AR/IE Correction
Specify the medicinal product, dosage regimen, and duration of treatment
V. Reporter Information
Full Name of the reporter *
Phone/Fax *
Email *
The report is provided by *
Name and location of the healthcare institution or applicant *
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Restrictions on obtaining information

You find yourself in a specialized publication, which is part of the site of Valatin Pharma LLC and is intended for medical institutions and doctors (the “certified medical specialists”) and contains professional specialized information about medicines, including prescription medicines, in particular, about their name, characteristics, methods of application, medicinal properties, possible side effects, possible contraindications, and other professional specialized information.

Information about preparations, including prescription medicines of PJSC Pharmaceutical company Darnitsa, is intended solely for familiarizing and is not a guide for self-diagnosis or treatment.

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