Non Serious Adverse Drug Reactions Report |
| Start Date:2015-10-21 End Date:2015-10-22 |
| Study :EMR700623-541 | Investigator :NA | Country of Investigator :China | SiteNo:C02 |
| Subject No :C02-0111 | Subject Initials :CXW | DOB :10/10/1979 | Sex:Female | Race:Asian | Height:162cm | Weight:68.0kg |
| First administration date of batch : | Batch number : |
| Study Drug | Start Date | Dose | Change in Dose |
| Gonal-f New Pen Stimulation Treatment | 05/20/2015 | 200 | |
| Adverse Event | Start Date | End Date | Time related to study treatment | Causality to study drug | Severity |
| OHSS | | | | Related | Moderate |
| Causality Factors | Action Taken with Study Treatment | Other action taken | Outcome | AE Special Interest | AE dose limiting toxicity |
| None(Othervalue:) | Not applicable | Led to study termination | Resolved | | |
| Event Description:Moderate OHSS patients, improved canceled after embryo transfer. |
| Subject received concomitant medications: |
| Does the subject have any relevant past or present medical conditions:Yes |
| Condition | Start Date | Related to study condition | Ongoing |
| Ectopic pregnancy laparoscopic surgery, the left fallopian tube embryo window. | Uk-Unk-2012 | Not on treatment/medication | |
| Tubal lipiodol angiography | Uk-Unk-2013 | Not on treatment/medication | |