[ Psycho-Babble | FAQ ]

Adverse Event Reports

Adverse events are undesirable and unintended responses to procedures. They're important to report because they may reflect risks to others about which there should be greater awareness. Please use this form to report adverse events that occur to you during your participation in Psycho-Babble.

This adverse event reporting process takes place on a secure web server, so information you submit is encrypted before it's sent, so you don't have to worry about it being intercepted. If you're curious, check the security of this server and your browser.

In general, you can tell if a web page is secure if:

There's a locked padlock at the bottom of your browser window.
The URL starts with "https" ("s" stands for "secure").
With a Netscape browser, under the View menu, under Page Info, under the Security tab, it tells you the connection is encrypted.

Submit Your Report

Submit (and revise) your report here.

Dr. Bob may contact you by email to follow up on this report. If this adverse event was related to the use of a drug, you may also wish to report it to the FDA.

[dr. bob]

Dr. Bob is Robert Hsiung, MD, dr-bob@uchicago.edu

Revised: April 18, 2003
URL: https://dr-bob.securesites.com/cgi-bin/pb/advent.pl

[ Psycho-Babble | FAQ | Adverse Event Reports ]

Date of the adverse event:
Your posting name:
Your password:
Detailed description of the adverse event:
"Serious" consequences, if any, of the adverse event:	persistent or significant disability or incapacity hospitalization or, if already hospitalized, prolongation of hospitalization substantial risk of dying congenital anomaly or birth defect
An adverse event should be reported here only if it occurred to you during your participation in Psycho-Babble. In addition to it occurring during your participation in Psycho-Babble, do you think it was caused by your participation in Psycho-Babble?	definitely probably possibly probably not definitely not