Report Adverse Drug Reaction

Dear Sir/Madam,

In accordance with the legal requirements, the Pharmaceutical Law Act of 6 September 2001, Polfa Warszawa, as the Marketing Authorization Holder, must collect all information on adverse reactions resulting from the use of its products as part of pharmacovigilance. This knowledge is used to constantly assess the safety profile of medicines and to take steps to minimize the side effects of our therapies, thus making our medicines safer for patients.

ADVERSE REACTION – ANY ADVERSE AND UNINTENDED EFFECT OF THE MEDICINAL PRODUCT.

In case of any adverse reaction resulting from the use of a Polfa Warszawa product, it can be reported to the Pharmacovigilance Department.

You can submit a report by sending a completed form by e-mail or by post to:

Pharmacovigilance and Medical Information Department
Zakłady Farmaceutyczne POLPHARMA S.A.
6 Bobrowiecka Street
00-728 Warsaw
Poland

e-mail: phv@polpharma.com
fax.: + 48 22 364 61 66
phone: + 48 22 364 61 00

NOTE

If you are a healthcare professional and you want to complete the form regarding a patient, download the Healthcare Professional Form. If you are a patient, download the Patient Form.

Patient Form

Healthcare Professional Form

Drug exposure during pregnancy and postpartum form

It is possible to report a side effect using an electronic form, which will be sent to the Pharmacovigilance and Medical Information Department for further processing.
The application will be analyzed by us; in the case of additional questions, a representative of the company will contact you for additional information.

For this purpose, please complete the MEDICINE SIDE EFFECT REPORTING FORM

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Report Adverse Drug Reaction