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2a02:4780:2b:1668:0:28eb:48fe:7  Public Scan

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Submitted URL: http://gruporodim.com/farmacovigilancia
Effective URL: https://gruporodim.com/farmacovigilancia/
Submission: On November 04 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST /farmacovigilancia/#quform-b757e7

<form id="quform-form-922a77" class="quform-form quform-form-1 quform-ajax-initialized" action="/farmacovigilancia/#quform-b757e7" method="post" enctype="multipart/form-data" novalidate="novalidate"
  data-options="{&quot;id&quot;:1,&quot;uniqueId&quot;:&quot;922a77&quot;,&quot;theme&quot;:&quot;&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:[],&quot;dependents&quot;:[],&quot;elementIds&quot;:[],&quot;dependentElementIds&quot;:[],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:false,&quot;pages&quot;:[1],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}">
  <button class="quform-default-submit" name="quform_submit" type="submit" value="submit" aria-hidden="true" tabindex="-1"></button>
  <div class="quform-form-inner quform-form-inner-1"><input type="hidden" name="quform_form_id" value="1"><input type="hidden" name="quform_form_uid" value="b757e7"><input type="hidden" name="quform_count" value="1"><input type="hidden"
      name="form_url" value="https://gruporodim.com/farmacovigilancia/"><input type="hidden" name="referring_url" value=""><input type="hidden" name="post_id" value="1300"><input type="hidden" name="post_title" value="Farmacovigilancia"><input
      type="hidden" name="quform_current_page_id" value="1"><input type="hidden" name="quform_csrf_token" value="wWqPcaMJndXFN7kwg8TwJOpqt8yuP1zYExFi5Xw7">
    <div class="quform-elements quform-elements-1 quform-cf quform-responsive-elements-phone-landscape">
      <div class="quform-element quform-element-page quform-page-1 quform-page-1_1 quform-cf quform-group-style-plain quform-first-page quform-last-page quform-current-page">
        <div class="quform-child-elements">
          <div class="quform-element quform-element-text quform-element-1_3 quform-cf quform-element-required">
            <div class="quform-spacer">
              <div class="quform-label quform-label-1_3"><label class="quform-label-text" for="quform_1_3_922a77">Nombre completo del reportante<span class="quform-required">*</span></label></div>
              <div class="quform-inner quform-inner-text quform-inner-1_3">
                <div class="quform-input quform-input-text quform-input-1_3 quform-cf"><input type="text" id="quform_1_3_922a77" name="quform_1_3" class="quform-field quform-field-text quform-field-1_3" placeholder="Nombre completo"></div>
              </div>
            </div>
          </div>
          <div class="quform-element quform-element-radio quform-element-1_4 quform-cf quform-element-required">
            <div class="quform-spacer">
              <div class="quform-label quform-label-1_4"><label class="quform-label-text" id="quform_1_4_922a77_label">¿Es profesional de la salud?<span class="quform-required">*</span></label></div>
              <div class="quform-inner quform-inner-radio quform-inner-1_4">
                <div class="quform-input quform-input-radio quform-input-1_4 quform-cf">
                  <div class="quform-options quform-cf quform-options-block quform-options-simple" role="radiogroup" aria-labelledby="quform_1_4_922a77_label">
                    <div class="quform-option"><input type="radio" name="quform_1_4" id="quform_1_4_922a77_1" class="quform-field quform-field-radio quform-field-1_4 quform-field-1_4_1" value="Si"><label for="quform_1_4_922a77_1"
                        class="quform-option-label quform-option-label-1_4_1"><span class="quform-option-text">Si</span></label></div>
                    <div class="quform-option"><input type="radio" name="quform_1_4" id="quform_1_4_922a77_2" class="quform-field quform-field-radio quform-field-1_4 quform-field-1_4_2" value="No"><label for="quform_1_4_922a77_2"
                        class="quform-option-label quform-option-label-1_4_2"><span class="quform-option-text">No</span></label></div>
                  </div>
                </div>
              </div>
            </div>
          </div>
          <div class="quform-element quform-element-text quform-element-1_5 quform-cf quform-element-required">
            <div class="quform-spacer">
              <div class="quform-label quform-label-1_5"><label class="quform-label-text" for="quform_1_5_922a77">Nombre completo del paciente que presenta la reacción adversa al medicamento<span class="quform-required">*</span></label></div>
              <div class="quform-inner quform-inner-text quform-inner-1_5">
                <div class="quform-input quform-input-text quform-input-1_5 quform-cf"><input type="text" id="quform_1_5_922a77" name="quform_1_5" class="quform-field quform-field-text quform-field-1_5" placeholder="Nombre completo del paciente">
                </div>
              </div>
            </div>
          </div>
          <div class="quform-element quform-element-row quform-element-row-1_6 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape">
            <div class="quform-element quform-element-column quform-element-1_7">
              <div class="quform-element quform-element-text quform-element-1_9 quform-cf quform-element-required">
                <div class="quform-spacer">
                  <div class="quform-label quform-label-1_9"><label class="quform-label-text" for="quform_1_9_922a77">País<span class="quform-required">*</span></label></div>
                  <div class="quform-inner quform-inner-text quform-inner-1_9">
                    <div class="quform-input quform-input-text quform-input-1_9 quform-cf"><input type="text" id="quform_1_9_922a77" name="quform_1_9" class="quform-field quform-field-text quform-field-1_9" placeholder="País"></div>
                  </div>
                </div>
              </div>
            </div>
            <div class="quform-element quform-element-column quform-element-1_8">
              <div class="quform-element quform-element-text quform-element-1_10 quform-cf quform-element-required">
                <div class="quform-spacer">
                  <div class="quform-label quform-label-1_10"><label class="quform-label-text" for="quform_1_10_922a77">Ciudad<span class="quform-required">*</span></label></div>
                  <div class="quform-inner quform-inner-text quform-inner-1_10">
                    <div class="quform-input quform-input-text quform-input-1_10 quform-cf"><input type="text" id="quform_1_10_922a77" name="quform_1_10" class="quform-field quform-field-text quform-field-1_10" placeholder="Ciudad"></div>
                  </div>
                </div>
              </div>
            </div>
          </div>
          <div class="quform-element quform-element-email quform-element-1_11 quform-cf quform-element-required">
            <div class="quform-spacer">
              <div class="quform-label quform-label-1_11"><label class="quform-label-text" for="quform_1_11_922a77">Correo electrónico<span class="quform-required">*</span></label></div>
              <div class="quform-inner quform-inner-email quform-inner-1_11">
                <div class="quform-input quform-input-email quform-input-1_11 quform-cf"><input type="email" id="quform_1_11_922a77" name="quform_1_11" class="quform-field quform-field-email quform-field-1_11" placeholder="Correo electrónico"></div>
              </div>
            </div>
          </div>
          <div class="quform-element quform-element-text quform-element-1_12 quform-cf quform-element-required">
            <div class="quform-spacer">
              <div class="quform-label quform-label-1_12"><label class="quform-label-text" for="quform_1_12_922a77">Número de teléfono<span class="quform-required">*</span></label></div>
              <div class="quform-inner quform-inner-text quform-inner-1_12">
                <div class="quform-input quform-input-text quform-input-1_12 quform-cf"><input type="text" id="quform_1_12_922a77" name="quform_1_12" class="quform-field quform-field-text quform-field-1_12" placeholder="00000000"></div>
              </div>
            </div>
          </div>
          <div class="quform-element quform-element-textarea quform-element-1_13 quform-cf quform-element-optional">
            <div class="quform-spacer">
              <div class="quform-label quform-label-1_13"><label class="quform-label-text" for="quform_1_13_922a77">Describa la reacción adversa al medicamento que presentó.</label></div>
              <div class="quform-inner quform-inner-textarea quform-inner-1_13">
                <div class="quform-input quform-input-textarea quform-input-1_13 quform-cf"><textarea id="quform_1_13_922a77" name="quform_1_13" class="quform-field quform-field-textarea quform-field-1_13"
                    placeholder="Escribe tu mensaje aquí..."></textarea></div>
              </div>
            </div>
          </div>
          <div class="quform-element quform-element-checkbox quform-element-1_14 quform-cf quform-element-required">
            <div class="quform-spacer">
              <div class="quform-label quform-label-1_14"><label class="quform-label-text" id="quform_1_14_922a77_label">Certifica que los datos brindados son verídicos y acepta brindarlos.<span class="quform-required">*</span></label></div>
              <div class="quform-inner quform-inner-checkbox quform-inner-1_14">
                <div class="quform-input quform-input-checkbox quform-input-1_14 quform-cf">
                  <div class="quform-options quform-cf quform-options-block quform-options-simple" role="group" aria-labelledby="quform_1_14_922a77_label">
                    <div class="quform-option quform-option-label-empty"><input type="checkbox" name="quform_1_14[]" id="quform_1_14_922a77_1" class="quform-field quform-field-checkbox quform-field-1_14 quform-field-1_14_1" value=""><label
                        for="quform_1_14_922a77_1" class="quform-option-label quform-option-label-1_14_1"></label></div>
                  </div>
                </div>
              </div>
            </div>
          </div>
          <div class="quform-element quform-element-submit quform-element-1_2 quform-cf quform-button-style-theme">
            <div class="quform-button-submit quform-button-submit-default quform-button-submit-1_2"><button name="quform_submit" type="submit" class="quform-submit" value="submit"><span class="quform-button-text quform-button-submit-text">Aceptar y
                  enviar</span></button></div>
            <div class="quform-loading quform-loading-position-left quform-loading-type-spinner-1">
              <div class="quform-loading-inner">
                <div class="quform-loading-spinner">
                  <div class="quform-loading-spinner-inner"></div>
                </div>
              </div>
            </div>
          </div>
          <div class="quform-element-tree"><label for="quform_1_0_922a77">This field should be left blank</label><input type="text" id="quform_1_0_922a77" name="quform_1_0" class="quform-field quform-field-tree quform-field-1_0" tabindex="-1"
              autocomplete="off"></div>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

 * Sobre Nosotros
 * Productos
 * Unete al equipo

Menú
 * Sobre Nosotros
 * Productos
 * Unete al equipo

 * Sobre Nosotros
 * Productos
 * Únete al equipo
 * Contactános

Menú
 * Sobre Nosotros
 * Productos
 * Únete al equipo
 * Contactános

Contactános



FARMACOVIGILANCIA


SERÁ UN PLACER ATENDER TUS DUDAS Y COMENTARIOS





FARMACOVIGILANCIA

La farmacovigilancia es la detección, evaluación, comprensión y prevención de
los efectos adversos de los medicamentos o cualquier otro problema de salud
relacionado con ellos.

PARA NOSOTROS TU SALUD ES LO MÁS IMPORTANTE

SI DESEAS NOTIFICAR QUE TRAS EL CONSUMO DE UNO DE NUESTROS MEDICAMENTOS HA
PADECIDO UNA REACCIÓN ADVERSA, COMPLETA EL FORMULARIO.

Nombre completo del reportante*

¿Es profesional de la salud?*
Si
No
Nombre completo del paciente que presenta la reacción adversa al medicamento*

País*

Ciudad*

Correo electrónico*

Número de teléfono*

Describa la reacción adversa al medicamento que presentó.

Certifica que los datos brindados son verídicos y acepta brindarlos.*

Aceptar y enviar

This field should be left blank
 * Calle Circunvalación, Polígono I Lote #3-4,
   Zona Industrial Plan de La LagunaAntiguo Cuscatlán, El Salvador.

 * (503) 2239 2500

 * comunicaciones@gruporodim.com

 * Productos
 * Contáctanos

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