REPORT A SIDE EFFECT OR MEDICAL ENQUIRY Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard Adverse events should also be reported to Servier Laboratories Limited by submitting this form or by calling us: 01753 666409 (Medical Enquiries). If you are a patient reporting a side effect please also talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. Please indicate whether you are a Patient, Healthcare Professional or Member of Public * Member of Public Healthcare Professional Patient Title? * Miss Mr. Ms. Mrs. Dr. Nurse Prof. Sir Sister Please indicate which drugs apply * Coversyl Arginine (perindopril) Coversyl Arginine Plus (perindopril/indapamide) Diamicron (gliclazide 80mg) Diamicron MR (gliclazide 30mg m/r) Lonsurf (trifluridine/tipiracil) Natrilix (indapamide 2.5mg) Natrilix SR (indapamide 1.5mg m/r) Oncaspar (pegaspargase) Onivyde pegylated liposomal (irinotecan) Pixuvri (pixantrone) Procoralan (ivabradine) Valdoxan (agomelatine) Other Please provide as much detail as possible. Providing more information enables us to respond more quickly. If you are based outside of the UK please visit www.servier.com and use Contact Us I confirm I have read the Privacy Statement below, and have read and accepted the Terms of Use (at bottom of page). Servier is committed to protecting your privacy. If you submit an enquiry, Servier Laboratories Ltd and Servier Research and Development Ltd will collect and process your personal information for the purposes of dealing with your enquiry. We will contact you if we require further information regarding your enquiry. All personal information you share with us in your enquiry will be processed in accordance with the EU General Data Protection Regulation, the Data Protection Act 2018 and all other applicable data protection laws. Please note you have certain rights regarding your personal information. For further information on our use of your personal information including your rights, please see our Privacy Notice accessible here: https://www.servier.co.uk/data-privacy/. If you provide us with any personal information relating to another person, you must ensure that you direct them to the Privacy Notice on our website as soon as possible. If you have any questions relating to our use of your personal information please contact us by email at datamanagementuk@servier.com or by post to the Compliance Department, Servier Laboratories Ltd, Sefton House, Sefton Park, Bells Hill, Stoke Poges, Slough SL2 4JS. * Required fields © 2019 LES LABORATOIRES SERVIER This site is intended for United Kingdom residents Servier does not sell its products over the Internet Terms of Use Data Privacy Cookies notice Report a side effect Servier Clinical Trials M-NO-UK-00444 Date of Preparation January 2021