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Information for Healthcare Professionals: Rosiglitazone maleate (marketed as Avandia, Avandamet, and Avandaryl)

Information for Healthcare Professionals
Rosiglitazone maleate (marketed as Avandia, Avandamet, and Avandaryl)

Please see the Drug Information page for rosiglitazone.

 

Report serious adverse events to
FDA’s MedWatch reporting system by completing a form on line at
http://www.fda.gov/medwatch/report/hcp.htm, by faxing (1-800-FDA-0178),
by mail using the postage-paid address form provided on line
(5600 Fishers Lane, Rockville, MD 20852-9787),
or by telephone (1-800-FDA-1088).

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YOUR CONTACT INFORMATION
First Name: *
Last Name: *
E-mail Address: *
Address:
City:
State: *
Zipcode:
Phone: -- xtn

CASE INFORMATION
Why Was Avandia Prescribed?: *
What Dosage, in Milligrams?:
How Frequently Was Avandia Taken?:
Date Patient Began Taking Avandia:

Stopped Taking Avandia:

What Symptoms Were Experienced?: *
Heart Attack
Stroke
Heart Failure

 Death
Other
PPH
If "Other", Please Describe:
How Long Was it From the Last Dose to the Problems Appearing?:
    Within 1 Day 2 Days 3 Days
    More Than 3 Days Don't Know
Questions/Comments:
This form is secure and encrypted. More information about secure forms and your privacy here.