Ilmoita haittavaikutuksista

Notice of adverse event with a pharmaceutical product

By this form you can report on suspected adverse event associated with the use of any of Avansor Pharma’s
medicines. The report can be submitted by you or by someone else on behalf of you. You can also contact us by sending an email at info@avansorpharma.fi

Your Name

I am..

Phone number

E-mail

THE PERSON WHO HAS BEEN AFFECTED

Gender

Age

INFORMATION ON THE MEDICINE AND ON THE SIDE EFFECTS

Suspected medicine

Batch number (Batch or Lot)

Strength of the medicine

Dose of the medicine

Date when the adverse event was noted

Description of the adverse event

* We collect and process the personal data you provide in connection with adverse event reports to fulfil our statutory obligations. See more detailed information in our privacy policy.

Notice of adverse event with a pharmaceutical product

* We collect and process the personal data you provide in connection with adverse event reports to fulfil our statutory obligations. See more detailed information in our privacy policy.

Privacy policy

Adverse event report

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