患者或(huo)報告人聯系(xi)方式(shi)/Patient or Report PhoneNumber
藥品名稱/Drug Name *
批準(zhun)文號/Approval Number
用藥原因/Medical Reasons
不良反應/Adverse Reactions *
用藥及不(bu)良反(fan)應(ying)過(guo)程描述/Medication and Description Of AdverseReactionProcess