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File Your Own Report Here

This National reporting center serves as a clearinghouse for anecdotal reports of possible side-effects or drug interactions for those using glucosamine and chondroitin supplements. Every few weeks, the results of any trends will be posted. If any side-effects or interactions are deemed significant, they will be reported to the media and to researchers using these supplements. Please answer the following important questions very carefully! Thank you, Jason Theodosakis, M.D.

Personal and Medical Information
This personal information is used to verify the accuracy of this report and will not be distributed to outside organizations. You may be contacted to verify authorship of your report.

First Name:

Last Name:

Sex Age: Date of Birth (MM/DD/YY):

Street Address:

City: State: Zip:

Country:

E-mail Address:

Phone (optional) Area Code: Number:

Medications you take regularly (generic or trade name)
Med1:
Med2:
Med3:
Med4:
Med5:
Med6:

Major medical diagnoses (eg. adult-onset diabetes, rheumatoid arthritis, hypertension, coronary artery disease, etc.)


Are you in the medical field?

If Yes was your response to the question above please list your occupation (e.g. pediatric nurse, internal medicine M.D., orthopedic D.O., etc)

Glucosamine & Chondroitin Supplement Information

Name of Glucosamine supplement taken:

Still taking for how long (in weeks):

Starting dosage used (# of pills):

How long on starting dose? (# of weeks):

Maintenance dosage used (# of pills):

How much glucosamine is in each pill (in mg.)



Name of Chondroitin supplement taken:

Still taking for how long (in weeks):

Starting dosage used (# of pills):

How long on starting dose? (# of weeks):

Maintenance dosage used (# of pills):

How much chondroitin is in each pill (in mg.)

Response

Average Response - Pain in joints
Improvement:

Average Response - Ability to do activities
Improvement:

After using the supplements, have you been able to stop your anti-inflammatory or pain pills for your arthritis?


Side-Effects and Drug Interactions

Side-effects (note: to confirm that the supplements have caused side-effects, report only those which appeared when starting the supplement, disappeared when you stopped.

For Glucosamine...

Medication Interaction (observed interactions between the Glucosamine supplement and one or more medicines)

Did the symptoms re-appeared if you tried the Glucosamine supplement again.


Side effects experienced with the Glucosamine supplement(i.e. abdominal bloating, constipation, diarrhea, indigestion, hives, rash, other-specify)


And for Chondroitin...

Medication Interaction (observed interactions between the Chondroitin supplement and one or more medicines)

Did the symptoms re-appeared if you tried the Chondroitin supplement again.


Side effects experienced with the Chondroitin supplement (i.e. abdominal bloating, constipation, diarrhea, indigestion, hives, rash, other-specify)


Tell your story in your own words:



 
 

Learn about and purchase the book

90% of people who follow The Arthritis Cure treatment program don't need anti-inflammatories (like Aleve, Celebrex or Advil).
Dr. Theo warned people that these drugs, used first... read more

 

  

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