of side effects
Report of side effects
In order to report an undesirable effect of a medicinal product, please complete the appropriate form below and return it by e-mail to email@example.com and the original to the following address:
REIG JOFRE Sp. z o.o.
ul. Ostródzka 74N
tel. +48 604 446 658
Please provide as much information as indicated in the form as possible. To be valid, a report must contain at least:
• Patient identification data (initials, age / date of birth, gender)
• Identification data of the reporting person (name, surname, address, telephone number)
• Name of the medicinal product suspected of causing the adverse reaction (batch number if known)
• Description of the side effect.