Report adverse reactions

If you would like to report an adverse reaction, please contact the Pharmacovigilance Department.

Below you can choose the form in which you would like to file the report.  

If you want to get medical advice, please contact a healthcare professional.

Send online report
Download report form
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1. Online report

2. Data of the patient who experienced adverse reaction

Sex

Pregnancy and breast-feeding

Pregnancy

Breast-feeding

Please describe observed adverse reactions

Suspected drug information

Trade name
Dose
Indications
Therapy dates (from/to)

Did reaction abate after stopping drug?

Did reaction abate after dose reduction?

Did reaction reappear after reintrodducing drug?

Did the patient take this drug previously?

If "yes", did the same reaction appear?

Did the same reaction appear after another drug intake?

Did patient develop the same reaction regardless of drug use?

Please specify other concomitant medications and dates of administration (from/to)

Trade name
Dose
Therapy dates (from/to)

Other relevant information(diseases, medical procedures, drugs, allergies, earlier symptoms, laboratory test results, diagnostic test results, past medical history, etc.)

This is to let you know that the Controller of personal data provided via our adverse reaction form is Biofarm Sp. z o.o. of Poznań, with address at ul. Wałbrzyska 13, 60–198 Poznań (NIP: 7780021575, REGON: 008029300, KRS: 0000120050) (“we”, “us” or the “Controller”)

Your personal data will only be processed for pharmacovigilance purposes in relation to our medicinal products.

You have the right at any time to access your personal data, to request their rectification or erasure or that their processing is restricted, and the right to object. You also have the right to lodge a complaint with the President of the Personal Data Protection Office (Prezes Urzędu Ochrony Danych Osobowych).

For full details of how we process personal data see our Privacy Policy (link here).

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