Reporting of suspected adverse reactions

Please fill in all the fields in the form below as part of the Pharmacovigilance process in order to promptly initiate contact and verification procedures.

Here you can find the complete information notice

for reporting adverse reactions.

For any other reports concerning medicines or medical devices, please refer to the contacts page

Name

Mandatory field

Surname

Mandatory field

E-mail adress

Please enter a valid email address.

Mobile number

Please enter a valid mobile number

Gender

Mandatory field

Age

Mandatory field

Drug name

Mandatory field

Onset date

Mandatory field

Treatment start date

Mandatory field

Subject of the report

Mandatory field

Acceptance of Privacy Terms -Complete privacy policy

to the processing of my personal and health data according to the methods and purposes indicated in points 1 and 2

Deny

Mandatory field

to the communication and transfer, including to non-EU countries, of my personal and health data to the subjects indicated in points 3 and 4

Deny

Mandatory field

Consent to contact the primary care physician

Deny

Mandatory field

in order to contact the primary care physician to request further information regarding the report.