To report an adverse drug reaction to our’s medicinal product, please complete the form.
A valid Individual Case Safety Report should include at least:
- One identifiable reporter’s data
- One single identifiable patient’s data
- Description of one adverse reaction (or more)
- The name of one suspect medicinal product
All other fields will help the assessment of the causal relationship between a suspected medicinal product and an adverse reaction.
You can also report an adverse drug reaction:
– by email to firstname.lastname@example.org
– by phone:
Medicinal products information : (+48) 71 38 59 642 (ext. 123)
Export Department: (+48) 71 385 96 16
Head office: (+48) 71 335 72 55
– by letter:
Wrocławskie Zakłady Zielarskie “Herbapol” SA
ul. św. Mikołaja 65/68, 50-951 Wrocław, Polska/Poland.