Pharmacovigilance: Adverse Event Reporting

Pharmacovigilance is a system that allows the monitoring of drug safety throughout their use by patients.This form allows you to report adverse effects related to the use of a medicine.

Name*

Last Name*

Gender*

Date of birth*

Drug Name*

Dosage*

Pharmaceutical form*

Lot Number*

Expiry Date*

Route of Administration*

Indication*

Posology*

Start Date of Treatment*

Duration of Treatment*

Description of the Adverse Event*

Date of Occurrence*

Concomitant Medications*

Email Address*

Phone Number*

The information collected here will be processed in accordance with our Pharmacovigilance Data Protection Policy. It is processed by SKYEPHARMA, which acts as the data controller, for the purpose of properly managing your request and keeping you informed about the evolution of our offers. Your data will be stored securely for a period of 3 years. You have the right to access, rectify, object to, restrict, port, and erase your personal data by contacting us at privacy@skyepharma.com