Entity: Hungary Document ID: CHUN-SD-000018

Effective See cover Version: 5.0 Pages 1

date
sheets Supported document ID: CHUN-SOP-000054
Phone contact form

CALL DATE: 21.06.2023 CALL DATE: 09:30

CALLED PARTY SANOFI-AVENTIS PRODUCT NO:

Clexane
NAME:
OCCUPATION:
CALLER NAME:NAGY ANITA
PHONE
NUMBER:
01626650 gmi inquiry data is at

SUMMARY OF THE CONTENT OF THE INVESTIGATION/CALL: Patient age: 63 years.

After surgery (she had a hysterectomy) she started taking Clexane in single daily doses. She started to have
menstrual-like bleeding as soon as she started taking the medicine and it intensified on day 16, THE heavy
bleeding lasted for 2 days, then decreased.
Once she stopped taking Clexane, the bleeding stopped completely the next day.
Her other medications are: she takes one nebilet 5mg tablets a day and half of covercard 10/5 a day, she has been
on both medications for years. She also takes calcium and vitamin D.

IF THE CALLER IS THE PATIENT, DO YES NO NOT ASKED

YOU HAVE ANY INFORMATION?

• Verbal authorisation for SANOFI-AVENTIS Zrt. to use confidential information x

about the patient from the patient

• Verbal explanation that we will handle the x

patient's data in accordance with data
protection laws
• Verbal authorisation for SANOFI-AVENTIS Zrt. to contact the patient's treating x
physician
• Verbal instruction that we process the treating physician's data in accordance
with data protection laws

SHORT LIST OF ACTIONS TO BE TAKEN FOLLOWING THE CALL (INCLUDING RECALL OF THE CALLER):
REQUEST FOR THE PUBLICATION OF THE PHONE CONTACT FORM (SIGNATURE/DATE) : Nagy Anita

DDigitally signed by: Nagy

Date:

Anita 2023.06.21

10:04:39

+02'00'

CHECKED THE COMPLETION OF THE TELEPHONE CONTACT FORM (SIGNATURE/DATE):

Digitally signed by Krisztina

Krisztina URBÁN-BÉKÁSI URBÁN-BÉKÁSI

Date: 2023.06.21 10:19:21 +02'00'

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been signed by the third party and prior approval is obtained from the Sanofi function owning this document.

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