HealthRX.com · Printable dose-error record
EGRIFTA exposure record for Poison Control or your prescriber
Use this after a possible tesamorelin dose error. It captures which EGRIFTA product you have, how the vial was mixed and drawn, what happened and when, and the label warnings worth mentioning on the call.
Which product
Carton saysEGRIFTA WR, EGRIFTA SV, or something else
Pharmacy and prescription number
Lot number and expiry date
Photo of vial and carton taken?yes / no
How it was mixed and drawn up
Liquid used to mix it, and how much
Date the vial was mixed
Volume drawn into the syringe (mL)
Syringe usedthe one supplied in the kit, or another
Injections given today, with times
What happened, in time order
| Time | Injection, symptom or call | Details | Who advised what |
|---|---|---|---|
Label facts to check your record against
- EGRIFTA WR: one dose is 1.28 mg in 0.16 mL, and one mixed vial gives daily doses for 7 days.[1]
- EGRIFTA SV: one dose is 1.4 mg in 0.35 mL of mixed solution.[2]
- EGRIFTA WR and EGRIFTA SV are not substitutable.[1]
Mention these on the call, and act on the first two straight away
- Collapse, a seizure, trouble breathing or not waking: call 911 immediately.[3]
- Rash, hives, swelling or trouble breathing: allergic reactions occurred in 4% of patients in trials, and the label says to seek prompt medical attention and stop treatment.[1]
- Thirst or high glucose readings: tesamorelin can cause glucose intolerance.[1]
- Swelling, joint pain or carpal tunnel symptoms: the label links these to fluid retention.[1]
- Any suspected overdose: call Poison Control at 1-800-222-1222.[3]
Sources for the facts on this sheet
- Theratechnologies Inc., via DailyMed. EGRIFTA WR (tesamorelin) for injection, for subcutaneous use: prescribing information, patient information and instructions for use. Effective 2026-07-29. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=839334d3-8c1d-4c26-9036-2ab524a6ea75
- Theratechnologies Inc., via DailyMed. EGRIFTA SV (tesamorelin) for injection, for subcutaneous use: prescribing information, patient information and instructions for use. Effective 2026-07-29. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3d783378-b02d-4f19-99dd-0fc91a042224
- U.S. National Library of Medicine. Tesamorelin Injection: MedlinePlus Drug Information. Accessed 2026-10-18. https://medlineplus.gov/druginfo/meds/a611035.html
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.