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Report adverse drug reaction

Adverse drug reaction is any adverse and unintended effect resulting from a medication.

 

If you want to report an adverse reaction which occurred when using Chiesi Group drugs, please:

  • print the Adverse Drug Reaction Reporting Form,
  • fill in the minimum information required for the report to be accepted:
    • initials, gender or age of the patient concerned,
    • first name and surname of the reporting person,
    • in the case of medical practitioners – address of the workplace,
    • signature of the reporting person, if the report is not submitted by electronic means,
    • name of the medicinal product which is suspected to have caused the said adverse reaction,
    • description of the adverse reaction,
  • sign and send a scan of the report to the following email address: info-pl@chiesi.com or by fax to: (22) 652 37 79,
  • send the original document by mail to the following address: Chiesi Poland Sp. z o.o., Al. Jerozolimskie 134, 02-305 Warszawa.

We will be grateful for any additional information on the adverse reaction beyond the minimum required. This will help us to establish a cause and effect relationship between the drug and the reaction.

Please also inform us about:

  • adverse drug reaction resulting from occupational exposure to the ready-made form of this drug
  • lack of drug reaction
  • use of the drug in pregnant or lactating women,
  • quality defects in the Chiesi Group’s medicines.



NOTE: For immediate notification of any adverse reaction or quality defect of the Chiesi Group product, please contact us at: +48 665 001 303.

 

Reporting forms:

Adverse drug reaction reporting form for the patient     

Adverse drug reaction reporting form for the doctor      

Form of use of the medicinal product during pregnancy     

 

We kindly inform you that your personal data voluntarily submitted for the purpose of reporting adverse reactions is administered by Chiesi Farmaceutici S.p.A. with its registered office at Via Palermo 26/A - 43122 Parma, Italy. Personal data will be made available to entities authorised by law. You have the right to access and correct your data. Any submissions and inquiries should be directed to Chiesi Poland Sp. z o.o. with its registered office at Al. Jerozolimskie 134, 02-305 Warsaw, acting on behalf of the data administrator.