Adverse Reporting Form

Please report any adverse effect observed after intake of our medicines below.

Patient's Initials *

Age in Years

Weight in Kgs

Height in cms

Description of Adverse Event *

Austex Suspect Drug *

Name of the Reporter *

Telephone / Cell Number of the Reporter

Confidentiality: The patient's identity is held in strict confidence and protected to the fullest extent. The company shall not disclose the reporter's identity in response to a request from the public. For more details on how we process your data for pharmacovigilance purposes please refer to our Privacy Policy.