Pharmacovigilance

Reporting adverse event or adverse drug reaction

The following information, appearing in Polish, refers to the reporting adverse event of adverse drug reaction only on territory of Poland. For more information in English please contact us: +48 22 350 70 55

Komtur Polska Sp. z o.o. makes a kind request to report all information on suspected adverse event or adverse drug reaction after the following medicinal products:

First Name*

Last Name*

E-Mail*

Im a*

Im located in*

Product or Active Substance*

Please enter the exact name of the Product or Active Substance.

Marketing Authorisation Holder*

Please enter the exact name of the Marketing Authorisation Holder. You can find this information in section 6 of the leaflet.

By submitting this form, you agree to be contacted by Komtur only if your case is in scope. If your report concerns a veterinary product, please use your local authority’s reporting route; Komtur will not receive your submission.Your personal data will only be processed and retained as necessary to manage this adverse event in line with our legal obligations and our contractual obligations with the Marketing Authorisation Holder (MAH) and/or the relevant authority.*

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