__________________________________________________________________________________________
Re: Local ID TH140804253 / TH201408010974 FU (1)
Thank you for reporting to us an adverse event related to Lilly product.
We would like to collect more information to better understanding the reported event.
Please respond to following questions regarding the adverse event – more pain in right knee, involving a female patient who was subscribed Forteo, reported the event to Lilly on 28/AUG/2014.
Please follow-up with Dr. Pornpong Itsarayapreuk, Maharaj Nakhon Chiangmai Hospital.
Please ask the following questions:
1. Was the hip and back surgery performed before starting Forteo?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
2. Was the patient hospitalized for the hip and back surgery?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
3. The reason for the hip and back surgery was stated as bone collapse due to osteoporosis; did the bone collapse occur before starting Forteo?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
4. Did the pain on hip and back started before Forteo?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
5. Did the pain on hip and back worsened while on Forteo?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
6. Did the pain of knee started before Forteo?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
7. Were any of these events related to Forteo? Please specify which one and the rationale:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Thanks
Yours sincerely,
ELI LILLY AND COMPANY
Sasithorn Suntharo
Pharmacovigilance Associate
HCP’s signature:
Date:
__________________________________________________________________________________
For Eli Lilly internal use only
Date of Confirmation of FU request sent to HCP:
Name and Designation: