Global Adverse reactions Pharmacovigilance is the public health activity that identifies, quantifies, evaluates and prevents the risks involved in the use of medicines once they have been authorized, thus allowing to follow up possible untoward effects of these medicines. Should you wish to notify a possible adverse reaction related to any of our products, please contact your physician or pharmacist or opt for one of the 3 following possibilities: Spanish Agency of Medicines and Medical Devices (AEMPS) Drug Safety and Pharmacovigilance ESTEVE notification form Notification form IF YOU ARE A PATIENT IF YOU ARE A HEALTH PROFESSIONAL The fields marked with * are required. NOTIFICATION OF SUSPECTED ADVERSE REACTION TO A MEDICINE Have you reported this adverse reaction to the Spanish Agency of Medicines and Medical Devices (AEMPS)? Select one option Yes No INFORMATION ABOUT THE PATIENT Name Surname E-mail* Telephone Gender* Male Female Birthdate* Location* Country* INFORMATION ABOUT THE PRODUCT Provide the name of the medicinal product suspected of causing the adverse reaction* Why were you receiving the medication? What was the daily dose? What was the administration route?(e.g. oral, topic, inhalation route) What were the dates of treatment? (start date, end date, or if you are still taking it) Did you discontinue the medication? Select one option Yes No Does not apply Indicate if you were taking other medicines, and which: INFORMATION ON THE ADVERSE REACTION Describe what happened to you* Did the adverse reaction resolve favorably? Select one option Yes No Other Indicate the start and end (if resolved) date of the adverse reaction Did you receive any treatment for the adverse reaction? Select one option Yes No ANOTHER INFORMATION Please indicate if you have suffered or suffer from any disease Have you ever notified this reaction to your physician?* Select one option Yes No Please add any comment you may deem relevant I am read and accept the legal Notice and the privacy policy. SEND About us Who we are Corporate governance Our global presence Our commitment Therapeutic areas Contract Manufacturing R&D Research Areas Pipeline Scientific publications Patients B2B Partnering Media Corporate resources Contact Adverse reactions Work with us Privacy Legal notice Cookies policy Last update 11/11/2021 | © 1996-2021 ESTEVE Use of cookies We use our own and third-party cookies for analytic, technical and profiling purposes; we process data that is needed to create profiles based on your browsing habits. Press the "ACCEPT COOKIES" button to confirm their use. You can change the configuration of your cookies by pressing "MORE INFORMATION AND CONFIGURATION". ACCEPT COOKIES MORE INFORMATION AND CONFIGURATION * *This option allows you to reject the cookies.