HealthRX.com · Printable question sheet
CJC peptide serious side effects questions for my prescriber
Use this sheet before talking with a prescriber or pharmacist about the CJC peptide, its serious events, the trial death, and growth hormone class risks. Fill it in by hand and bring it to the visit or keep it at home.
My details and what I have noticed
Write only what you observed. Leave blank anything you do not know.
Product name exactly as labeledCopy the wording on the vial or box
Where I got itClinic, pharmacy, website or other source
Date I first used it
Chest discomfort or palpitations noticedDescribe when it happened and how long it lasted
Heart rate reading and device usedWrite the reading and the time it was taken
Flushing, warmth, dizziness or light headednessDescribe the feeling and when it started
Swelling, fluid or blood sugar concernsWrite any changes you have seen or measured
Bring or confirm before the visit
Bring these to the appointment or have them ready.
- Bring the product box, vial and any packaging that mentions research use only
- List every other medicine, supplement and peptide, including blends with ipamorelin
- Note any growth hormone prescriptions you have had in the past
- Bring the log below showing dates, injection site reactions and heart rate notes
- Confirm whether the pharmacist has checked the product's approval status
- Write down the name of the clinic or seller that supplied the product
Questions to ask the prescriber or pharmacist
- Is this CJC peptide approved for any use in my country?
- Has the serious heart event reported by FDA been discussed with my history?
- What heart rate and blood pressure changes should prompt me to call you?
- Does this product carry the growth hormone risks on approved labels?
- What is known about blood sugar and fluid retention with this product?
- Could a trial death in people with HIV affect my decision to use this?
- What testing would you want before I continue or stop this product?
- Who should I contact if I notice chest discomfort after an injection?
Injection and symptom diary
Record each injection and any change over the following days.
| Date | Injection site notes | Heart rate noticed | Other symptoms |
|---|---|---|---|