Cross-Sell Path

Enter the Upsell Path to identify the call. This will default to whatever was used for the last call logged.

Reason Code

Use the dropdown to select a reason. Reason Category must be selected first before using the drop down.

Customer

Enter or search for the customer account number. For more on searching for accounts, go here.

Communicated by

Enter the method of contact. This will default to whatever was used for the last call logged.

Regarding Product

Enter the item number the contact was associated with.

Respond with

Select The correct Adverse Event Questionnaire for your affiliate

Note Text

Enter the details of the contact here.

What type of call was this?

Select one of the following:

• ST - Serious

• NS - Not Serious

If serious, why?

 If serious select all that apply from the list below: 

• Life-Threatening Experience

• Hospitalization or Doctor/E.R. Visit

• Medical Intervention to Prevent Permanent Damage

• Other Serious: Important Medical Events

• Pregnant Woman Giving Birth to a Child with Birth Defects

• Death

Product Name

 Enter the name of the product being discussed. 

Reactions/Symptoms Reported

 Select any of the symptoms reported from the listings below: 

• NA) Nausea

• HE) Headache

• DZ) Dizziness

• AR) Acid Reflux/Heartburn

• DI) Diarrhea

• VM) Vomiting

• SC) Stomach cramping

• GI) Indigestion

• RA) Rash/Hives

• RI) Red/Irritated Skin

• BN) Burning sensation on skin

• BD) Low blood pressure

• BP) High blood pressure

• B2) Low blood sugar

• BS) High blood sugar

• JP) Joint pain

• WG) Weight gain

• IH) Irregular heartbeat

• AL) Allergic Reaction

• OT) Other

If Other chosen above

 If OT was chosen above, fill in the reaction/symptom in this field. 

AE Description- What did Customer Share?

Enter notes here for any additional information the customer has included during the call. 

Lot Number

 Enter the lot number from the product. The lot number is usually printed on the bottom of the bottle. 

Expiration date of product

Enter the expiration date of the product. The date is printed on the bottle. 

Was Safety Call used

Select one of the following:

• Transferred

• Unsuccessful Transfer

• Did Not Offer Transfer

• LFW N/A

• OV N/A

If the transfer to Safety Call was Unsuccessful, why?

Enter information here detailing why the transfer was not completed successfully. 

Were you confused about whether or not this was an Adverse Event?

Select one of the following:

• Yes

• No

Were you confused as to whether this was a serious Adverse Event?

Select one of the following:

• Yes

• No

If yes to either, explain. 

If the above field was yes, enter in details explaining why.