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:
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