Non Serious Adverse Drug Reactions Report |
| Start Date:2016-01-11 End Date:2016-01-15 |
| Study :EMR700623-541 | Investigator :Fei Gong | Country of Investigator :China | SiteNo:C01 |
| Subject No :C01-0158 | Subject Initials :T-Y | DOB :06/17/1983 | Sex:Female | Race:Asian | Height:163cm | Weight:47kg |
| First administration date of batch : | Batch number : |
| Study Drug | Start Date | Dose | Change in Dose |
| Gonal-f New Pen Stimulation Treatment | 09/16/2015 | 112.5 | |
| Adverse Event | Start Date | End Date | Time related to study treatment | Causality to study drug | Severity |
| OHSS | 10/12/2015 | 10/15/2015 | | Related | Moderate |
| Causality Factors | Action Taken with Study Treatment | Other action taken | Outcome | AE Special Interest | AE dose limiting toxicity |
| None(Othervalue:) | Not applicable | Concomitant procedure** | Resolved | | |
| Event Description: |
| Subject received concomitant medications: |
| Does the subject have any relevant past or present medical conditions:Yes |
| Condition | Start Date | Related to study condition | Ongoing |
| right fallopian tube is less patency,left fallopian tube is obstruction | 06/04/2015 | Not on treatment/medication | Ongoing |
| Endometrial polyps hyperplasia | 08/24/2015 | Not on treatment/medication | Ongoing |