Report a side effect

If you noticed a side effect or an unwanted reaction after using one of our products, please tell us. Your report is confidential and only our drug-safety (pharmacovigilance) team can read it.

If the patient is seriously unwell, call your local emergency number now or go to the nearest hospital. This form does not replace urgent medical care.

۱About you

Who are you? * Patient or carer Doctor, pharmacist or nurse Other

Full name * Phone *

Email City

Speciality / workplace

۲About the patient

Patient initials Age Sex Weight (kg)

Pregnant

۳Product used

Product of interest * Batch / lot number

Other product (exact name)

What was it used for? Dose and how it was used

Start date Stop date

۴The reaction

Describe the reaction *

Reaction start date Current status

Was the reaction serious? Resulted in death Was life-threatening Caused or prolonged hospitalisation Caused lasting harm or disability Birth defect in a newborn Other medically important event

Other medicines or products used at the same time Relevant medical history or allergies

Photo or document (optional)Photo of the reaction or product, or a doctor's report — JPG, PNG or PDF up to 8 MB

I agree that the drug-safety team may contact me for more information and send the report (without my name) to the health authority.

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