Report a side effect

    Report information





    Information on primary source(s) (Report Details)

    Patient Characteristics

    Death

    Information about the medicine


    Add all Rameda suspect products

    Please list the Rameda product(s) which you suspect could have caused the side effect(s). You can add more than one suspect Rameda product, if needed. Simply click 'add suspect product'.

    The batch/LOT number is printed on the packaging of the medicine and on the product. If you do not have the number, leave the field empty.


    Side effect description

    Please list the side effect(s) which you would like to report. You can report more than one side effect, if needed. Simply click 'add side effect'.


    Consent and data privacy

    Notice of personal data processing*

    [acceptance* acceptance-rameda-privacy] By submitting this form, I agree to Rameda privacy and disclaimer information [/acceptance]