HealthRX.com · Printable side-effect diary
Mounjaro injection site reaction diary and visit sheet
Use this sheet to record where each Mounjaro injection was given and any skin reaction afterward. Bring the completed log and answers to your prescriber or pharmacist to review rotation sites and reactions together.
Medicine and injection details
Fill in before your first entry. Keep this page with your log.
Medicine name and strengthAs printed on your pen or label
Prescriber name and phoneWho manages your Mounjaro
Pharmacy name and phoneWhere you collect refills
Usual injection dayDay of the week you inject
Who gives the injectionYou, or another person for the back of the upper arm
Allergies you already know aboutInclude any reaction to medicine ingredients
Site and reaction log
Record each injection. Note the site, any redness, swelling, itching or pain, and how long it lasted.
| Date | Site used | Reaction seen | How long it lasted | Other notes |
|---|---|---|---|---|
Before the visit
- Bring the completed site and reaction log
- Note the sites you have rotated and any you have repeated
- Bring the pen or carton you have been using
- Check with your pharmacist that the solution looked as expected
- List any other medicines or supplements you take
- Confirm your prescriber contact for reactions between visits
- Note the date and symptoms of any reaction that felt more than local
Questions to ask your prescriber or pharmacist
- Which injection sites are recommended for me?
- How should I rotate sites from one dose to the next?
- What reaction pattern should prompt me to call you?
- Is a repeated reaction at one site something to report?
- What signs of a serious allergic reaction should I watch for?
- Should I stop and seek care if a reaction spreads or worsens?
- Could my antibody status be relevant to my reactions?
- Are any of my other medicines or supplements relevant to these reactions?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.