Patients

PATIENT DETAILS

Patient Name*

Age/Date of birth*

Gender

Email address

Location

Contact*

Weight

DRUG DETAILS

Name of suspected drug

Source of suspected drug

Pharmacy/Chemical Shop

Hospital/Health

Facility

REACTION DETAILS

Headache

Fever

Diarrhoea

Nausea/Vomiting

Rashes

Cough

Other

DETAILS OF REPORTER IF DIFFERENT FROM PATIENT DETAILS

Full name

Contact

Relationship with patient

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Age

Location

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About Pokupharma

Pokupharma Limited is a limited liability company registered under the companies code 1963(Acts 179). Having complied with the provisions of companies’ code, it commenced business on 5th March, 1998 to supply pharmaceutical products under the pharmacy act 1994(Act 489) section 30 and 31.

Catalog Categories

Tablet
Syrup
Capsules
Cream
Injection
Suspension
Drop

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