{"id":4085,"date":"2024-10-01T08:48:53","date_gmt":"2024-10-01T08:48:53","guid":{"rendered":"https:\/\/galaxy.al\/?page_id=4085"},"modified":"2024-10-25T06:08:25","modified_gmt":"2024-10-25T06:08:25","slug":"reporting-side-effects","status":"publish","type":"page","link":"https:\/\/galaxy.al\/?page_id=4085","title":{"rendered":"Reporting side effects"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><div class=\"vc_row wpb_row vc_row-fluid\"><div class=\"\"  ><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner  \"><div class=\"wpb_wrapper\"><div class=\"vc_empty_space\"   style=\"height: 32px\"><span class=\"vc_empty_space_inner\"><\/span><\/div>\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h2 style=\"text-align: left;\">Reporting side effects<\/h2>\n\n\t\t<\/div>\n\t<\/div>\n<div class=\"vc_separator wpb_content_element vc_separator_align_center vc_sep_width_20 vc_sep_border_width_4 vc_sep_pos_align_left vc_separator_no_text vc_sep_color_blue wpb_content_element  wpb_content_element\" ><span class=\"vc_sep_holder vc_sep_holder_l\"><span class=\"vc_sep_line\"><\/span><\/span><span class=\"vc_sep_holder vc_sep_holder_r\"><span class=\"vc_sep_line\"><\/span><\/span>\n<\/div>\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p>If you notice side effects that may be caused by the use of Galaxy sh.p.k. medicines, do not hesitate to inform us.<\/p>\n<p>For this purpose you may contact us by:<\/p>\n<p>Email: <a href=\"mailto:info@galaxy.al\">info@galaxy.al<\/a><\/p>\n<p>Address: <a href=\"https:\/\/maps.app.goo.gl\/FFWpkZfz44536KfG7\" target=\"_blank\" rel=\"noopener\">Galaxy sh.p.k., Rruga \u201cSk\u00ebnder Vila\u201d 1022, Tirana, Albania<\/a><\/p>\n\n\t\t<\/div>\n\t<\/div>\n\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h2 style=\"text-align: center;\">The Reporting Formulary<\/h2>\n\n\t\t<\/div>\n\t<\/div>\n<div class=\"vc_separator wpb_content_element vc_separator_align_center vc_sep_width_20 vc_sep_border_width_4 vc_sep_pos_align_center vc_separator_no_text vc_sep_color_blue wpb_content_element  wpb_content_element\" ><span class=\"vc_sep_holder vc_sep_holder_l\"><span class=\"vc_sep_line\"><\/span><\/span><span class=\"vc_sep_holder vc_sep_holder_r\"><span class=\"vc_sep_line\"><\/span><\/span>\n<\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vc_row wpb_row vc_row-fluid\"><div class=\"\"  ><div class=\"wpb_column vc_column_container vc_col-sm-2\"><div class=\"vc_column-inner  \"><div class=\"wpb_wrapper\"><\/div><\/div><\/div><\/div><div class=\"\"  ><div class=\"wpb_column vc_column_container vc_col-sm-8\"><div class=\"vc_column-inner  \"><div class=\"wpb_wrapper\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4084-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"4084\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F4085#wpcf7-f4084-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"4084\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4084-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p><b>In case of medical emergencies please contact immediately your doctor, pharmacist and \/ or the emergency department.<\/b>\n<\/p>\n<p><label>Please complete the following formulary and then click <b>\u201cSubmit\"<\/b><\/label>\n<\/p>\n<p><b>1. To whom does this report apply?<\/b>\n<\/p>\n<p>This report is about <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-374\"><span class=\"wpcf7-form-control wpcf7-radio radio1\" id=\"radio1\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-374\" value=\"me\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">me<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-374\" value=\"a child \/ my child\" \/><span class=\"wpcf7-list-item-label\">a child \/ my child<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-374\" value=\"another person\" \/><span class=\"wpcf7-list-item-label\">another person<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><b>2. Informations about the patient who experienced the side effect.<\/b>\n<\/p>\n<p><label> Name, Last Name or Initials <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label><br \/>\nBirthday <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-0\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-0\" \/><\/span><br \/>\nSex <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-621\"><span class=\"wpcf7-form-control wpcf7-radio radio2\" id=\"radio2\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-621\" value=\"Male\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-621\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-621\" value=\"Rather not say\" \/><span class=\"wpcf7-list-item-label\">Rather not say<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><b>3. Informations about the drug that is suspected to have caused the side effect.<\/b>\n<\/p>\n<p>Drug name and dose (<i>e.g. Rokivit D3 28000IE<\/i>) <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-254\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-254\" \/><\/span>\n<\/p>\n<p>Dosage (<i>e.g. 400 mg twice daily<\/i>) <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-90\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-90\" \/><\/span>\n<\/p>\n<p><b>4. Informations about the experienced side effect.<\/b>\n<\/p>\n<p>Description of the signs \/ symptoms (<i>e.g. itching, redness etc.<\/i>) <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-818\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-818\" \/><\/span>\n<\/p>\n<p><b>5. Additional information.<\/b>\n<\/p>\n<p><label> Give as much details as possible (optional)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><b>6. Informations about the reporter.<\/b>\n<\/p>\n<p>Name, Surname <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-574\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-574\" \/><\/span>\n<\/p>\n<p>Telephone <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-975\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-975\" \/><\/span>\n<\/p>\n<p><label> Your email <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Address <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address\" \/><\/span> <\/label>\n<\/p>\n<p>Town <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-216\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-216\" \/><\/span>\n<\/p>\n<p>Country <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-190\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-190\" \/><\/span>\n<\/p>\n<p>The patient and the reporter are the same person? <b>(*)<\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-535\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-535\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-535\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div><\/div><\/div><\/div><div class=\"\"  ><div class=\"wpb_column vc_column_container vc_col-sm-2\"><div class=\"vc_column-inner  \"><div class=\"wpb_wrapper\"><\/div><\/div><\/div><\/div><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"Reporting side effects If you notice side effects that may be caused by the use of Galaxy sh.p.k. medicines, do not hesitate to inform us. For this purpose you may contact us by: Email: info@galaxy.al Address: Galaxy sh.p.k., Rruga \u201cSk\u00ebnder Vila\u201d 1022, Tirana, Albania The Reporting Formulary In case of medical emergencies please contact immediately [...]","protected":false},"author":1,"featured_media":0,"parent":176,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_themeisle_gutenberg_block_has_review":false,"footnotes":""},"class_list":["post-4085","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/galaxy.al\/index.php?rest_route=\/wp\/v2\/pages\/4085","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/galaxy.al\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/galaxy.al\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/galaxy.al\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/galaxy.al\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4085"}],"version-history":[{"count":28,"href":"https:\/\/galaxy.al\/index.php?rest_route=\/wp\/v2\/pages\/4085\/revisions"}],"predecessor-version":[{"id":4314,"href":"https:\/\/galaxy.al\/index.php?rest_route=\/wp\/v2\/pages\/4085\/revisions\/4314"}],"up":[{"embeddable":true,"href":"https:\/\/galaxy.al\/index.php?rest_route=\/wp\/v2\/pages\/176"}],"wp:attachment":[{"href":"https:\/\/galaxy.al\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4085"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}