1: State your e-mail address:
2: Pet's name/species/breed/sex/age:
3: What 'drug' your pet was given [Rimadyl,
ProHeart6, Deramaxx etc.] that resulted in an ADE [adverse
drug reaction], and if known, the drug manufacturer name:
4: The approximate date of the event:
5: The adverse reaction[s] YOU observed
and/or became aware of [nausea, vomiting, diarrhea, seizures,
inability to walk, gastric ulceration, liver failure, kidney
damage, death, etc.] - please list ALL known and/or suspected
symptoms/conditions:
6: What State this occurred in:
7: Whether or not your veterinarian informed
you of the potential/possible risks/side effects BEFORE
dispensing the named drug, stating whether such information
was provided verbally and/or in written form:
8: Where you learned about the potential/possible
risks/side effects of the drug [i.e., www.srdogs.com, etc.]:
9: State whether or not you would still
have allowed the drug to be given to your pet had you KNOWN
of the potential/possible risks/side effects:
10: The original reason you took your pet
to the veterinarian [toenail clipping, vaccinations, injury,
any symptoms]:
11: How was your pet's health/life affected
after taking this drug?
12: Permission to post email with Survey?