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Did you experience any discomfort with a Liomont medicine?

If you experienced any discomfort after using a Liomont product, it could be a case of an adverse drug reaction (ADR) suspicion.

If that’s the case, please report it to our professionals in the following form:

1. Data of the patient who suspects an adverse reaction
Initials or patient name*:


Age:

Gender:WM


2. Suspicious drug
Product Liomont:

Lot number:

Expiration date:

Start date of treatment:



3. Suspected Adverse Drug Reaction
Start date of adverse reaction:

Description of the adverse reaction: *



4. Notifier Data
Name of the person reporting the reaction: *

Phone (LADA): *

Hours available to receive a call-up (if necessary):

Email:



5. Additional comments:

Do you wish to be contacted by Liomont Laboratories Pharmacovigilance staff?
YESNOT

I accept the Privacy Statement*

*Required fields


NOTE: All requested information is confidential and will be processed by the Drug Safety Unit of Laboratorios Liomont, S.A. de C.V. in strict adherence to the Privacy Notice, the Federal Law for the Protection of Personal Information in Possession of Private Entities, and the normativity in force applicable to pharmacovigilance.

Or, if you prefer to, send the following information to the contact options available:

  1. Patient’s initials
  2. Liomont Product
  3. Reaction description
  4. Telephone number or e-mail address of the person sending the report.

(55) 5814-1200 ext:1331
Business Hours M-F 8:00 to 16:00

farmacovigilancia@liomont.com.mx

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