Adverse Event Reporting

Fields marked with ^* are mandatory
 

Adverse event or special situation

Please provide the adverse event term in your local language. You may report up to six adverse events. Please include one term per field.

Narrative

Describe the event and provide any relevant additional information that you wish to include in your local language.

Case seriousness

Assessment should always be done by a health care professional.

Patient details

If known, please provide the patient's date of birth only, if unknown, you may provide either the patient's age or age group.

Additional comments

Data privacy

In order to respond to your enquiry it is necessary to collect some personal information such as your name and contact details. If you have queries concerning personal data or data privacy, please see our data privacy policy