Suspected adverse reaction report

Administrative details
Drugs information
Please, quote a dosage form & strength, daily dose, therapy dates (from-to), batch number and concomitant medicinal products and/or food supplements
Adverse reaction information
Physician contact details

* - mandatory information

By sending an adverse event report you acknowledge that PRO.MED.CS Praha a.s., reg. no.: 00147893, registered address: Telčská 377/1, Michle, 140 00 Prague 4, Czech Republic, is authorised to process your personal data. For more information click here.