Javascript is required to load this page.
Page Loaded
Enhancing Drug Adverse Event Surveillance: UCSD Fluoroquinolone Effects Study
Registration
This form is to be used for registering for the UCSD Fluoroquinolone Effects Study. You may use it whether you believe that you have suffered an adverse reaction to fluoroquinolone (FQ) antibiotics during use and/or after cessation or you believe that you tolerated them. Fluoroquinolones are a class of antibiotics, of which there are many examples. Example fluoroquinolone antibiotics include drugs like ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), and gatifloxacin (Zymar), and others.
Registering allows us to contact you with individualized links to questionnaires. Using the personalized links, you may start a questionnaire, take a break, and resume from the page where you left off for up to 1 month after starting it.
---This data will be used for research purposes only. Your personally identifying information will not be released outside the research study group.---
To navigate the form, use the navigation buttons labeled with "Next >>" or "<< Back" in the lower right corner of each web page. Do not use your web browser's "back" button.
0%
Current Progress 0%
100%
Copyright ©2014 Regents of the University of California, the Golomb Research Group, and their affiliates. All rights reserved.
Survey Powered By
Qualtrics