News and events

Name of reporter (if you do not want to enter your details - enter Anonymous)*

Reporter’s phone number*

Reporter’s e-mail address*

Specify the name of the person with the adverse reactions

Specify the age of the person with the adverse reactions

Products suspected to result adverse event (-s)

(name, formulation, dose and route(s) of administration, date of therapy start)

Consent to personal data collection and processing