Adverse Event Reporting | World Medicine

Adverse Effect Notice

We kindly request the health professionals and consumers / patients to inform us regarding any kinds of adverse effects related to the medical products of our company:

Adverse Effects:

Medical errors / errors related to the medical products
Use of medical products for unapproved and unstudied indications (off-label use)
Acute and chronic intoxication
Death cases occurring with the use of medical products
Abuse of medical products
Adverse effects of medical products upon the interaction with medical products, chemical substances and food
Inactivity of medical products

ADVERSE EFFECT REPORTING FOR HEALTHCARE PROFESSIONALS
ADVERSE EFFECT REPORTING FOR PATIENT/CONSUMER

For healthcare professionals

Information on healthcare professionals who observed side effect

Phone

E-mail

Patient Name Last Name

Patient Phone

Patient E-mail

Information on suspected medical product (drug)

Trade name (Please write the full name of the medicine, e.g. 10mg tablet)

Description of the side effect or inadequate effect *

Please state as much as possible what it is and how it is.*

You can add other information about the development of the side effect.

I consent to the processing of my personal data in accordance with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018 *

For patients

Information on the patient

Phone

E-mail

Information about the person making the notification

Phone Number

E-mail

Information on suspected medical product (drug)

Description of the side effect or inadequate effect *

Please state as much as possible what it is and how it is.*

You can add other information about the development of the side effect.

I consent to the processing of my personal data in accordance with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018 *

Adverse Effect Notice

For healthcare professionals

For patients

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