logo
logo_text
flagen
flagru
flagby
flagen
We are located at
Hotline
E-mail
Report problems associated with the use of the drug
You can fill out an electronic adverse reaction/lack of therapeutic efficacy report form.
A healthcare or pharmaceutical professional reporting an adverse reaction
Select type
Treatment
Select type
Message
Patient information
Choose an option
Specify the gender of the patient
Choose an option
Impaired liver function
Choose an option
Impaired renal function
Suspected drug
Other medications taken at the same time
Indicate "no" if no other medication was taken
Result of discontinuing the suspected drug
Select an option
Assessing causation
Select an option
Exodus
Select an option
Measures taken
Select an option
Criteria for classifying as serious adverse reactions (check the box if it fits)
Select an option
Whether a recurrence of an adverse reaction has been noted after a second prescription of the medication
Select an option
The suspected drug is used in
Select an option
Important additional information
Clinical, laboratory, radiological, and autopsy findings, including blood (tissue) drug concentrations, if any, associated with an adverse reaction (please provide dates)
For congenital abnormalities, list all other medications taken during pregnancy and the date of the last menstruation (indicate "no" if no such medications exist)