Adverse Event Report

Report

reporttype1Version of Safety Report ID1receivedateformat102transmissiondateformat102fulfillexpeditecriteria1Safety Report ID10172711serious1Date Last Updated15/05/2014receiptdateformat102companynumbUS-RANBAXY-2014US-81083occurcountryUSseriousnessother1duplicate1Date Received15/05/2014transmissiondate12/12/2014primarysourcecountryUS

Primary Source

reportercountryUSqualification5

Patient

SexMale

Reaction

1)

reactionmeddraversionpt17.0ReactionSuicidal ideationOutcomeUnknown

2)

reactionmeddraversionpt17.0ReactionSuicidal behaviourOutcomeUnknown

3)

reactionmeddraversionpt17.0ReactionDepressionOutcomeUnknown

4)

reactionmeddraversionpt17.0ReactionSocial problemOutcomeUnknown

Drug

1)

drugcharacterization1medicinalproductABSORICAdrugauthorizationnumb021951drugdosagetextUNKdrugdosageformCAPSULEdrugadministrationroute065drugindicationPRODUCT USED FOR UNKNOWN INDICATIONactiondrug5

openFDA Info on Medication

Application NumberNDA021951Brand NameABSORICAGeneric NameISOTRETINOINManufacturersSun Pharmaceutical Industries, Inc.product_ndc 10631-115, 10631-116, 10631-117, 10631-118, 10631-133, 10631-134, 10631-002, 106 ... Product TypeHUMAN PRESCRIPTION DRUGRouteORALActive IngredientsISOTRETINOINRXCUI 197843, 197844, 197845, 403930, 1299203, 1300006, 1300014, 1300016, 1547561, 154 ... spl_ida8d4793a-5043-40e1-b623-35812733499fspl_set_id3ef0cff8-19c1-4441-b780-fca6c7ee1615Package NDC 10631-115-69, 10631-115-31, 10631-116-69, 10631-116-31, 10631-117-69, 10631-117- ... NUIN0000175607, M0018962Established Pharmacologic ClassRetinoid [EPC]Chemical StructureRetinoids [CS]UNIIEH28UP18IF

2)

drugcharacterization1medicinalproductAMNESTEENdrugdosagetextUNKdrugdosageformCAPSULEdrugadministrationroute065drugindicationPRODUCT USED FOR UNKNOWN INDICATIONactiondrug5

Report Duplicate

duplicatesourceRANBAXYduplicatenumbUS-RANBAXY-2014US-81083

Receiver

receivertype6receiverorganizationFDA

Sender

sendertype2senderorganizationFDA-Public Use