Report A Side Effect

Report a side effect Contact Us

Who We Are

Who We Are
EIPICO was established in Tenth of Ramadan City in 1980, with a capital of EGP 7 Million.
Manufacturing Facilities

Manufacturing Facilities
EIPICO is the Leading Egyptian Pharmaceutical Company, in Production, by Units. It is the Major Provider of Antibiotics, Lyophilized products and Spansule Capsules, to the Egyptian market.
Science & Medicine

Science & Medicine
EIPICO provides High Quality Pharmaceutical Products at reasonable prices, thus assisting human healthcare improvement .
Global

Global
EIPICO is ranked Number 1 in Egyptian Exports of Pharmaceutical Products, capturing 29% of Egypt’s Total Exports of Pharmaceutical Products, by Value.
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EIPICO 3

EIPICO 3
The First Modular Biological and Biosimilar Facility in Egypt
- EIPICO 3 (Biologicals & Biosimilars)

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1 Who are you
2 Product
3 Side Effect
4 Patient
5 Contact Details
6 Summary

Country *

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Who are you? *

Member of public (eg. yourself, a patient, friend, parent or carer)

Health care provider (HCP)

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Product name *

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Active Ingredient *

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How is this medicine related to the side effect? *

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When did the person experiencing the side effect start taking the medicine? *

Start Date	This field is required
End Date	This field is required

Why did they take this medicine?

Which formulation of the medicine were they taking?

How did they take it? *

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What dose were they taking? *

Please enter a valid value. This field is required

Other Dosage [e.g. 24/26 mg or other]

How often did they take it?

What action was taken with the medicine as result of the side effect? *

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Batch number:

Side Effect *

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What was the outcome of the side effect? *

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How long did the patient experience the adverse event? *

Start Date	This field is required
End Date	This field is required

Please provide below if you consider there is a causal relationship between the event and the suspect product(s) and/or any additional detail(s) for the event(s) or treatment(s)

Was the side effect serious? *

Unknown

No, it was not serious

Yes, it was serious

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How serious was the side effect?

Resulted in death

Was life threatening

Resulted in or prolonged hospitalization

Resulted in a disability or was incapacitating

Resulted in a congenital anomaly or birth defect

Medically Significant

About the person experiencing the side effect

Gender *

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What are the initials of the person?

Age *

This field is required Please enter a valid value.

Height

Please enter a valid value.

Weight

Please enter a valid value.

Date of birth

Patient’s medical history

Please provide results of tests/labs, medical history, allergies, etc: *

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Please upload any relevant documents:

Contact Reporter

Email address

Is Reporter the Patient?

Yes

No

Someone I know

A patient I support

Your title:

First name *

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Last name

Address line 1

Address line 2

Town/City

Phone number: *

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Contact a health care professional

First name *

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Last name

Address line 1

Address line 2

Town/City

Country:

Phone number: *

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Profession: *

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Name of hospital, clinic etc: *

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Email Address:

Adverse Event Privacy *

I authorize EIPICo. and any of its affiliates to collect and analyze the information I provide for the purpose of assessing side effects related to my use of an EIPICo.'s product, and to disclose this information to health authorities in my country and other countries around the world as required by law or regulation. All information pertaining to this report, as well as any follow up inquiries for additional medical details, shall be in accordance with the EIPICo. patient safety reporting privacy notice.

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WE ARE EIPICO

EIPICO was established in Tenth of Ramadan City in 1980, with a capital of EGP 7 Million, currently raised to EGP 1500 Million.

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Contact Us

EIPICO, Tenth of Ramadan City - 1st Industrial Zone B1, Egypt.

Telephone : +20554499199
Fax : +20554499306

eipico@eipico.com.eg

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