Pharmacovigilance

Report a Suspected Adverse Event

Reports help improve the safety of medicines. Please submit only information you consent to share, and provide only the minimum patient-identifying details required.

Adverse Event Report

Not for medical emergencies. If this is a medical emergency, contact the nearest emergency medical service or treating healthcare professional immediately. Submission of this form does not provide emergency medical assistance.

ReporterReporter name *

Reporter type *

Mobile

Patient (minimum details only)Patient initials only

Age or age group

Sex

EventSuspected product *

Batch number (if available)

Date of event

Seriousness

Current status

Treating doctor (optional)

Event description *

Concomitant products

Supporting file (optional)

I acknowledge that this information is provided voluntarily for pharmacovigilance purposes and may be shared with regulatory authorities where required.

I consent to Scarley Pharmaceuticals contacting me regarding this enquiry and processing my information in accordance with the Privacy Policy.