Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :Fei GongCountry of Investigator :ChinaSiteNo:C01
Subject No :C01-0001Subject Initials :TTWDOB :05/13/1988Sex:FemaleRace:AsianHeight:157cmWeight:41.5kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/16/2015112.5
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS06/06/201506/15/2015RelatedModerate
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Not applicableConcomitant procedure**Resolved
Event Description:Nausea, vomiting, yellow urine with less volume, chest pelvic effusion,ascites puncture 10-Jun-2015,2200ml;ascites puncture 15-Jun-2015,2900ml;
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
Bilateral fallopian tube obstruction04/11/2014Not on treatment/medicationOngoing



06-APR-16
Fei Gong/EMR700623-541/C01-0001
Page 1 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :Fei GongCountry of Investigator :ChinaSiteNo:C01
Subject No :C01-0068Subject Initials :X-SDOB :04/16/1989Sex:FemaleRace:AsianHeight:160cmWeight:43kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment06/27/2015150
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS07/23/201508/04/2015RelatedSevere
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Not applicableConcomitant procedure**Resolved
Event Description:Abdominal distension, Nausea, yellow urine with less volume, chest pelvic effusion,Ascites puncture 23Jul2015,1000ml; 27Jul2015,2100ml; 30Jul2015,2500ml; 04Aug2015,2000ml;
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
The left Hydrosalpinx and adhesions,less patency.Right fallopian tube partially blocked03/22/2014Not on treatment/medicationOngoing
right fallopian tube resection because of Ectopic pregnancyUK-Oct-2011Not on treatment/medication



06-APR-16
Fei Gong/EMR700623-541/C01-0068
Page 2 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0010Subject Initials :Y-HDOB :10/18/1985Sex:FemaleRace:AsianHeight:153cmWeight:47.0kg
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
OHSS05/29/201506/02/2015RelatedModerate
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
Concomitant medication**(Othervalue:)Not applicableLed to study terminationResolved
Event Description:Moderate OHSS occurs canceled transplant
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:No
ConditionStart DateRelated to study conditionOngoing



06-APR-16
NA/EMR700623-541/C02-0010
Page 3 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0102Subject Initials :HYDDOB :10/14/1985Sex:FemaleRace:AsianHeight:163cmWeight:57.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/19/2015150
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS riskRelatedModerate
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Not applicableNone
Event Description:
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
Palace laparoscopy Uk-Unk-2013Not on treatment/medication



06-APR-16
NA/EMR700623-541/C02-0102
Page 4 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0178Subject Initials :XSCDOB :10/11/1988Sex:FemaleRace:AsianHeight:155cmWeight:54.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/27/2015200
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS06/10/201506/16/2015RelatedModerate
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
HSG: bilateral tubal resistance. Uk-Jan-2013Not on treatment/medication
Laparoscopy surgery: pelvic adhesions dissection, bilateral salpingo-repair plastic surgery, normal uterine shape.Uk-Jan-2013Not on treatment/medication
Hysteroscopy normal, water surgery: incomplete right fallopian tube obstructionUk-Feb-2015Not on treatment/medication



05-APR-16
NA/EMR700623-541/C02-0178
Page 5 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0179Subject Initials :HYZDOB :05/14/1991Sex:FemaleRace:AsianHeight:158cmWeight:53.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/27/2015150
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS06/11/201506/16/2015RelatedModerate
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 laparotomy: the left fallopian tube removal.Uk-Unk-2009Not on treatment/medication
Abdominal ectopic pregnancy conservative surgery.Uk-Unk-2010Not on treatment/medication
Hysteroscopy: endometrial polyp excision.Uk-Jan-2015Not on treatment/medication



05-APR-16
NA/EMR700623-541/C02-0179
Page 6 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0180Subject Initials :YPWDOB :08/20/1982Sex:FemaleRace:AsianHeight:156cmWeight:57.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/27/2015225
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS06/13/201506/16/2015RelatedModerate
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: treatment of chemical drugs to kill embryosUk-Unk-2012Not on treatment/medication
HSG: bilateral tubal occlusionUk-Unk-2008Not on treatment/medication



05-APR-16
NA/EMR700623-541/C02-0180
Page 7 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0185Subject Initials :YMXDOB :09/07/1975Sex:FemaleRace:AsianHeight:159cmWeight:63.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/28/2015225
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS06/15/201506/20/2015RelatedModerate
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
HSG: bilateral tubal occlusion Uk-Unk-2013Not on treatment/medication



05-APR-16
NA/EMR700623-541/C02-0185
Page 8 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0190Subject Initials :F-HDOB :03/09/1984Sex:FemaleRace:AsianHeight:160cmWeight:55.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/28/2015150
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS06/12/201506/16/2015RelatedModerate
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
 



05-APR-16
NA/EMR700623-541/C02-0190
Page 9 of 46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :ChinaSiteNo:C02
Subject No :C02-0191Subject Initials :SYZDOB :02/16/1983Sex:FemaleRace:AsianHeight:162cmWeight:58.0kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/28/2015200
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS06/14/201506/18/2015RelatedModerate
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
HSG: bilateral tubal occlusion with effusionUk-Unk-2008Not on treatment/medication
Tubal treatment: Tips patencyUk-Unk-2008Not on treatment/medication
 



05-APR-16
NA/EMR700623-541/C02-0191
Page 10 of 46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :Ying ZhongCountry of Investigator :ChinaSiteNo:C05
Subject No :C05-0001Subject Initials :XFZDOB :01/21/1988Sex:FemaleRace:AsianHeight:159cmWeight:50kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment08/01/2015225
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS08/16/201508/18/2015RelatedSevere
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Dose not changedConcomitant medication **Resolved
Event Description:
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
oophorocystectomyUK-Jul-2013Not on treatment/medication
salpingoplastyUK-Feb-2014Not on treatment/medication
salpingitis after previous tubal occlusionUK-Feb-2014Not on treatment/medicationOngoing



06-APR-16
Ying Zhong/EMR700623-541/C05-0001
Page 11 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :KoreaSiteNo:K01
Subject No :k01-0059Subject Initials :LKHDOB :08/05/1981Sex:FemaleRace:AsianHeight:153cmWeight:74kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment06/02/2015225
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS06/13/201507/02/2015RelatedMild
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Dose not changedLed 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



06-APR-16
NA/EMR700623-541/k01-0059
Page 12 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :KoreaSiteNo:K01
Subject No :k01-035Subject Initials :PSSDOB :01/19/1983Sex:FemaleRace:AsianHeight:161cmWeight:56kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment03/11/2015225
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS03/23/201504/21/2015RelatedMild
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Dose not changedLed 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



06-APR-16
NA/EMR700623-541/k01-035
Page 13 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :KoreaSiteNo:K01
Subject No :k01-036Subject Initials :JSYDOB :07/28/1981Sex:FemaleRace:AsianHeight:162cmWeight:54kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment03/13/2015225
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS03/24/201504/07/2015RelatedModerate
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Dose not changedLed 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



06-APR-16
NA/EMR700623-541/k01-036
Page 14 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :KoreaSiteNo:K01
Subject No :k01-040Subject Initials :LBHDOB :03/05/1985Sex:FemaleRace:AsianHeight:164cmWeight:61kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment04/06/2015225
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS04/15/201504/30/2015RelatedMild
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Dose not changedLed 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



06-APR-16
NA/EMR700623-541/k01-040
Page 15 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :KoreaSiteNo:K01
Subject No :k01-049Subject Initials :PGRDOB :02/20/1983Sex:FemaleRace:AsianHeight:168cmWeight:62kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/02/2015300
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS05/13/201505/29/2015RelatedMild
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Not applicableConcomitant medication **,Led to study terminationResolved
Event Description:albumin treatment and resloved
Subject received concomitant medications:
Does the subject have any relevant past or present medical conditions:Yes
ConditionStart DateRelated to study conditionOngoing
laparoscopic ovary cystectomyUK-UNK-2004Not on treatment/medication



06-APR-16
NA/EMR700623-541/k01-049
Page 16 of46
 

Non Serious Adverse Drug Reactions Report

Start Date:2016-04-05 End Date:2016-04-06
Study :EMR700623-541Investigator :NACountry of Investigator :KoreaSiteNo:K01
Subject No :k01-050Subject Initials :KHGDOB :04/22/1984Sex:FemaleRace:AsianHeight:150cmWeight:46kg
First administration date of batch :Batch number :
Study DrugStart DateDoseChange in Dose
Gonal-f New Pen Stimulation Treatment05/03/2015300
Adverse EventStart DateEnd DateTime related to study treatmentCausality to study drugSeverity
OHSS05/14/201505/29/2015RelatedMild
Causality FactorsAction Taken with Study TreatmentOther action takenOutcomeAE Special InterestAE dose limiting toxicity
None(Othervalue:)Dose not changedLed 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
ovary cystectomyUK-Jan-2014Not on treatment/medication



06-APR-16
NA/EMR700623-541/k01-050
Page 17 of46