Report a side effect

Report about a suspected adverse drug reaction

You can use this form to send us a direct message about a suspected adverse drug reaction (ADR).

If you have any questions about adverse reactions when using our medicinal products, please do not hesitate to contact us.
We will provide you with further information if necessary. If you report a suspected adverse drug reaction, we will also ask you to document your observations.

What is an adverse drug reaction or special safety relevant event and why should it be reported?

A side effect (also known as an adverse drug reaction) is a harmful and unintended reaction to a medicinal product. Special safety relevant events may also occur during the use of medicinal products, such as use during pregnancy or breastfeeding, overdose, misuse, medication errors or off-label use.
As a pharmaceutical company, we have an interest in, and a legal obligation to monitor, evaluate, prevent and report adverse reactions (including suspected adverse reactions) and special events related to the use of our medicinal products.
By reporting, you will help us to continually evaluate the risks and benefits of our active ingredients and contribute to the safe use of our medicinal products.

How does reporting work?

You can enter your details online using the form below. Please complete the mandatory fields (*) and add as much information as possible.
Any information relating to you as the reporter, or which could be used to identify the patient, will be treated as strictly confidential.

Click the "Send ADR form" button to send the information to the following address:

medac GmbH Pharmacovigilance
Theaterstraße 6
22880 Wedel

Telephone: +49 4103 / 8006-777
Fax: +49 4103 / 8006-9130

Step 1: Patient data

Sex *
How would you like to enter the patient's age (at the time of the ADR)? *
Is the patient / the patient‘s partner pregnant or breastfeeding?
Did the ADR occur during a clinical trial or study?

Step 2: Anamnesis

Please report all underlying disease(s):
Anamnestic features

Step 3: Suspected adverse drug reaction (ADR)

Please enter any diagnoses. If none have been made yet, please record all symptoms.

Step 4: Drug(s)

Please enter all drug(s) used.

Step 5: Reporter information

Reporter information *
I agree to be contacted in case of any further questions. *
Mandatory fields are marked with a *.
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