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Pharmacovigilance

Report an adverse reaction and/or lack of effectiveness of a medicinal product

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Card-message on an adverse reaction (AR) and/or lack of effectiveness (LE) of a medicinal product for consumers

If you, or a person you are helping, experienced an adverse reaction or a lack of effectiveness from a medicinal product, please fill out this form. The information you provide helps us monitor drug safety.

1

Patient information

2

Suspected medicinal product

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3

Reporter information

4

Doctor and healthcare facility information

ATTENTION! All fields are required!