Adverse Drug Reaction Reporting Form

Report an Adverse Drug Reaction

filling the form

What is an Adverse Drug Reaction (side-effect)?
It is any unintended medical occurrence in a patient-administered treatment with a product/drug. It can be any sign or symptoms associated with the use of the product/drug.

Why report an Adverse Drug Reaction?
If you report your adverse reaction/side-effect, you will support the high safety standards of Grünenthal products/drugs: the monitoring of Adverse Drug Reactions (side-effects) is essential for safe use of a product/drug and the protection of our patients. In addition, you will enable Grünenthal to comply with its reporting obligation to the health authorities.

In this form fields marked with an asterisk (*) are mandatory fields.

Please provide us with as much information as you have about the medication that you suspect caused the Adverse Drug Reaction/side-effect.

Reporting Form

1. Information about the adverse drug reaction
2. Information about the suspected drug
3. Patient information
4. Reporter details

Please complete the mandatory fields as highlighted between section 1 and 4.

last update:  03.12.2014