Medicinal products for human use

Have you been taking Krka medicines and have noticed an adverse reaction? Please let us know about it by filling in the following form.

CHOOSE ONE WAY FOR RECEIVING REPORTS ON ADVERSE REACTION

A) SIMPLE TEXT

If you want to report an adverse reaction or ineffectiveness of the drug, please call tel. __________ or send a message to the email address Pharmacovigilance.XY@krka.biz.

B) FORM (TRANSLATION NEEDED)

Patient information

Information on the person who reported the adverse reaction

Have you consulted a doctor, pharmacist or other healthcare professional about the adverse reaction, or has the patient done so?

yes

On whose behalf are you reporting this adverse reaction?

for myself

for someone else

Information on the person who experienced the adverse reaction

Gender

male

female

NEXT STEP

Medicinal product

Information on the medicinal product that caused the adverse reaction

This image shows where you can locate the batch number:

I can’t find the batch number

Has the patient stopped taking the medicine?

yes

Had the patient been taking any other medicine before the adverse reaction occurred?

yes

GO BACK NEXT STEP

Adverse reaction

Description of the adverse reaction and related information

If you wish you can even upload an image or a file with the description of the adverse reaction.

Remove file

Has the patient received a medicine for treating the adverse reaction?

yes

Additional and legal information

May we contact you if we require additional information?

yes

We would like to inform you that by reporting the adverse reaction you will be sending your personal information to Krka, d. d., Novo mesto, Slovenia. Krka is required to process and store such information in line with legislation on medicines. Your data will only be used for monitoring, analysing and reporting about product safety. Please find more details about personal data protection here.

GO BACK

Report on adverse reaction

Your report has been successfully recorded. You will receive a summary of the report on your email address.

Legal notice

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.