Pharmacovigilance

Feedback for consumers

Please report any suspected adverse reaction or lack of efficacy for the medicinal product.

Fields marked with * are required

Qualified Person Responsible For Pharmacovigilance
Krasnenkova Tatiana Petrovna
+375 (17) 268-63-64 info@academpharm.by
Full name *
Contacts (Phone / E-mail / Address) *
Years old *
Gender

Suspect drug information

Trade name of the medicinal product that you used (see packaging) *
Serial number (see packaging)*

Information on adverse reactions / lack of therapeutic efficacy / intolerance

Case description *

Feedback for specialists

Please report any suspected adverse reaction or lack of efficacy for the medicinal product.

Fields marked with * are required

Qualified Person Responsible For Pharmacovigilance
Krasnenkova Tatiana Petrovna
+375 (17) 268-63-64 info@academpharm.by

Medical or pharmaceutical worker reporting an adverse reaction

Full name *
Country *
Professional affiliation *
Contacts (Phone / E-mail / Address) *

Patient information

Full name of the patient *
Years old *
Gender *
Contacts (Phone / E-mail / Address)
Medication

Suspect drug information

Trade name of the medicinal product that you used (see packaging) *
Serial number (see packaging)

Information on adverse reactions / lack of therapeutic efficacy / intolerance / drug interactions

Case description *