Non Serious Adverse Drug Reactions Report

Start Date:2016-02-03 End Date:2016-02-22
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0002Subject Initials :LLLDOB :02/12/1987Sex:FemaleRace:AsianHeight:158cmWeight:50.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/08/2015150
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS05/25/201506/03/2015RelatedModerate
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Not applicableLed to study terminationResolved
Event description:
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
salpingemphrxis,lalace peritoneoscopeUk-Jul-2014Not on treatment/medication
 



17-FEB-16
NA/EMR700623-541/C02-0002
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Non Serious Adverse Drug Reactions Report

Start Date:2016-02-03 End Date:2016-02-22
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0011Subject Initials :P-XDOB :12/07/1994Sex:FemaleRace:AsianHeight:160cmWeight:60.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/11/2015150
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS05/27/201506/03/2015RelatedModerate
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Not applicableLed to study terminationResolved
Event description:
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
ectopic pregnancy Salping ectomyUk-Unk-2013On treatment/medication
 



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NA/EMR700623-541/C02-0011
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Non Serious Adverse Drug Reactions Report

Start Date:2016-02-03 End Date:2016-02-22
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0023Subject Initials :JYFDOB :11/10/1981Sex:FemaleRace:AsianHeight:163cmWeight:70.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/12/2015300
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS05/30/201506/05/2015RelatedModerate
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Not applicableLed to study terminationResolved
Event description:
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
Hysteroscopy Salpingemphraxis Uk-Mar-2015Not on treatment/medication
 



17-FEB-16
NA/EMR700623-541/C02-0023
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Non Serious Adverse Drug Reactions Report

Start Date:2016-02-03 End Date:2016-02-22
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0026Subject Initials :HCJDOB :07/07/1993Sex:FemaleRace:AsianHeight:161cmWeight:53.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/12/2015200
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS05/30/201506/05/2015RelatedModerate
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Not applicableLed to study terminationResolved
Event description:
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
Laparotomy with left tubal ectopic pregnancy resectionUk-Unk-2011Not on treatment/medication
Under ectopic pregnancy laparoscopic conservative surgeryUk-Unk-2012Not on treatment/medication
 



17-FEB-16
NA/EMR700623-541/C02-0026
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Non Serious Adverse Drug Reactions Report

Start Date:2016-02-03 End Date:2016-02-22
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0029Subject Initials :XLXDOB :06/08/1981Sex:FemaleRace:AsianHeight:158cmWeight:70.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/12/2015250
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS06/01/201506/07/2015RelatedModerate
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Not applicableLed to study terminationResolved
Event description:
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
Pelvic mass laparoscopic pelvic surgery sticky points, bilateral tubal ostomy, left ovarian drilling, tubal.Uk-Unk-2013Not on treatment/medication
 



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NA/EMR700623-541/C02-0029
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Non Serious Adverse Drug Reactions Report

Start Date:2016-02-03 End Date:2016-02-22
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0034Subject Initials :L-ZDOB :09/04/1981Sex:FemaleRace:AsianHeight:156cmWeight:53.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/13/2015150
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS05/30/201506/05/2015RelatedModerate
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Not applicableLed to study terminationResolved
Event description:
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:No
ConditionStart DateRelated to study conditionOngoing
 



17-FEB-16
NA/EMR700623-541/C02-0034
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Non Serious Adverse Drug Reactions Report

Start Date:2016-02-03 End Date:2016-02-22
Study :EMR200136_583Investigator :NACountry of Investigator :RomaniaSiteNo:006
Subject No :006-0005Subject Initials :DOB :08/28/1965Sex:FemaleRace:CaucasianHeight:165(cm)Weight:70(kg)
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Visit 2 (Month 3)03/11/20158
Visit 1/ Baseline (Day 1)03/11/20158
Visit 4 (Month 9)03/11/20158
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
increased liver enzimes06/11/2015SuspectedMild
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Dose not changedNoneOngoing
Event description:
Subject received concomitant medications:Yes
Name of medicationStart DateOngoingEnd DateDoseUnitFrequency
desloratadinum08/22/201509/09/20155miligramsqd
liv 5208/22/2015Yes275miligramsqd
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
thrombophiliaYes
arterial hipertensionYes
peripheral artheriopathyYes



03-FEB-16
NA/EMR200136_583/006-0005
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