Welcome to KILEN Consumer Data base Reports concerning effects/side-effects of medicines
Sex
Men Female
Hometown and Country
Age
Report submitted by
Consumer Relative Doctor Other
Medicine
Medicine prescribed for following illness/condition
Dose
Start date
Stop date
Effect 1
Under After
Effect 2
Effect 3
Other medicines currently being taken
Other illnesses/conditions than that mentioned above
Your own story
Name
Address
Telephone
Telefax