Report Adverse Drug Reaction

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:

POLPHARMA Biuro Handlowe
ul. Bobrowiecka 6
00-728 Warszawa

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

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

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