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Torsade de pointes and QT prolongation AESI Form 11-0092-F-V-1

$120.00

The Torsade de point and QT prolongation AESI form includes 2 pages of detailed questions to healthcare professionals to assess case causality.

Document Description

The  Torsade de pointes and QT prolongation AESI Form asks the relevant questions over two pages for a medical assessment and potential relationship determination for the medicinal product – including:

  • Patient information
  • Medication
  • Signs and symptoms
  • Laboratory measures
  • Relevant findings
  • Patient history
  • Risk factors

The form comes ready to use and adapt for your company.