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Reporting Adverse Effects and Feline Injection Site Sarcomas

Reporting is fundamental to detecting safety and product issues as well as helping veterinarians and researchers accurately establish a safety profile for FIP treatment.  Reports made here will be processed and entered into a ​publicly accessible safety database.

In order to protect the privacy of the reporting individual, pet owner, veterinary professionals, and any other individuals associated with a case, all individually identifying information will be removed before any records are made available publicly.  Contact information provided will only be used by site administrators to follow up on questions regarding the submission -- this  data will not be shared with anyone else without the individual's express consent to do so.

Reporting Individual's Information

Your Name:

Your relationship to the animal experiencing the adverse reaction:

Your Email:

If you chose "Other, please explain:

Locality

In what country did the adverse effect occur?

Patient Information

Patient Name:

Breed:

Overall Health Status When Suspected Product Given:

Species:

Gender:

Patient Age:

Suspected Product Information

Name of product causing suspected adverse effect:

Active ingredient (as advertised)

Dosage form (Injection, capsule, tablet, topical, etc.)

Strength of Active Ingredient:

Diagnosis and/or Reason for Use of the Product

Date of first exposure

Date of last exposure

Duration of Product Use

Product Use Information for Suspected Product

Dose administered

Route of administration

Interval of Administration (Frequency)

Product administered by

Adverse Event Information

Veterinarian’s Level of Suspicion that Product Caused the Adverse Event

Outcome:

Describe the adverse effect:

Treatment of adverse effect:

Date of Onset of Adverse Event:

Date of Onset of Adverse Event:

Length of Time Between First Exposure to

Suspected Product(s) and Onset of Adverse Event

Length of Time Between Last Administration of Suspected Product(s) and Onset of Adverse Event

When the Adverse Event Occurred, Treatment with Suspected Product:

If you chose "other" above, please specify:

You may upload documents with supporting information:

Select File

Please list any concurrent clinical problems:

Were Concurrent Products Given?

Please provide name(s), dose(s), interval(s), date(s) of treatment(s), and other relevant information to describe other products that the patient was taking at the time of the event.

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Adverse Effects and FISS Database

Coming soon

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