• Where Quality is Paramount

Adverse Drug Reaction Report

An adverse event is any untoward medical occurrence that may occur in a subject administered a medicine and this does not necessarily have to have a causal relationship with the treatment. The adverse event can be any unfavourable and unintended sign (e.g. an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.

If you are a doctor / pharmacist / other healthcare professional and would like to report an adverse drug reaction that your patient has experienced when taking one of our medicinal products, please complete the Adverse Drug Reaction Reporting Form for healthcare professionals.

If you are a patient or patient’s guardian or representative and you have any information concerning an adverse drug reaction experienced after use of any of SyriMed medicinal products, please complete the Adverse Drug Reaction Reporting Form for non-healthcare professionals (i.e. patient or patient’s guardian or representative).

The report will be analysed by the Pharmacovigilance staff at SyriMed who may contact you for additional information.

Please be advised that the personal data collected in the report will be processed by Syri Ltd. t/a SyriMed (Unit 4, Bradfield Road, Ruislip, Middlesex, HA4 0NU, United Kingdom) and used exclusively for the purposes related to the obligation that is placed by regulatory authorities on companies holding marketing authorisations for medicines to monitor the safety of the medicines they market.

All the information and personal data you share with us will be protected and kept confidential in line with SyriMed standard opertating procedures and local regulations. The information you provide will be used for the purpose of drug safety surveillance and may be shared anonymously with Medicines Regulatory Authorities. You have a right of access to your personal data which we hold about you.

ADVERSE DRUG REACTION REPORTING FORM

Form for the healthcare professional

ADVERSE REACTION REPORTING FORM

Form for non-healthcare professional