Log in ID:

Or....

Proxy ID Log in:

Enter Disease Primary:

Medications Taken:

submit

SELECT TRIAL PHASES

Name of Study Enrolled/Participating In:

Initial Study
Phase 1
Phase 2
Phase 3
Phase 4
Continous Study

CHECK SYMPTOMS BEING EXPERIENCED

Headache

Pain

Vomiting

Coughing

Shivering

Other Reactions:

Other Reactions:

Other Reactions:

REACTIONS TO MEDICATION BEING TAKEN AND DEGREE

Cold 0-2 2-4 4-6 6-8 8-10

Headache 0-2 2-4 4-6 6-8 8-10

Pain 0-2 2-4 4-6 6-8 8-10

Vomiting 0-2 2-4 4-6 6-8 8-10

Coughing 0-2 2-4 4-6 6-8 8-10

Shivering 0-2 2-4 4-6 6-8 8-10

Itching 0-2 2-4 4-6 6-8 8-10

Other Reactionary Attribution