Name *

    Email *

    Phone *


    DeathLife-threateningCongenital anomalyRequires inpatient hospitalisation or prolongation of existing hospitalizationResults in persistent or significant disability or incapacityRequired intervention to prevent permanent injury

    Other (Specify)

    Report Source


    Other (Specify)

    Product Type

    DrugVaccineHerbal ProductsCosmeticsDiagnostics

    Other (Specify)

    Action Taken

    Drug withdrawDose reducedFrequency reducedDose increasedTherapy changedRequired treatment with prescription medicationNo action was taken

    Current patient condition

    RecoveredRecoveringNo ImprovementUnknown

    Other (Specify)

    Does the event happened because of Quality Issue


    Does the product stored according to the instructions


    Quality observation

    Physical, chemical or microbial changesPresence of ParticlesSuspected contaminationNo effectPackagingLabeling problems (caused by printing errors / omissions)Product confusion (caused by name, labeling, design or packaging)

    Other (Specify)

    Sample Availability


    Did the physician or pharmacist had been informed

    YesNoI don’t Know

    Did the physician or pharmacist submit ADR report

    YesNoI don’t Know

    Can we get more information from the responsible physician

    YesNoI don’t Know


    About SITCO

    SITCO PHARMA as leading pharmaceutical company , Covering all regions in Kingdom of Saudi Arabia through four main branches, western, central, eastern and southern region.

    Additional sales offices will be available in Madinah, Qasim and Makkah cities.

    Reach us

    For general Information:
    For Complaint or Suggestions:

    Image result for telephone clipart images Tel. : +966 12 6647699 Ext. 14 Or 15
    Ramadan Working Hours: Sunday – Thursday: 09:30 – 15:30
    Friday – Saturday: Closed