Adverse events reporting form

Over the last few years, adverse events reporting in the bio-med world has proved its necessity. Some medicines and medical devices have been tested, re-assessed or even recalled, due to adverse effects or quality issues.

If you suspect that any of our products may have caused an adverse reaction to you or one of your patients, please fill in the form below.  A reference number will be sent to you shortly after form submission.

It is highly important that you provide all known information, including patient’s medical history. No personal or classified data is required.

Please fill in the form below:

Reported by:

 

Information on the suspected product:

 

Additional information (if known):

 

Details of the adverse reaction

 

Additional information (if known):

 

Details of the patient: (INITIALS ONLY!)

 

Additional Information:

 

Additional information: Please upload any additional files, if needed.

 

Reporter details:

 

Verification

 

Strategic Regulatory Affairs Services