Report side effects

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:

  1. One identifiable reporter’s data
  2. One single identifiable patient’s data
  3. Description of one adverse reaction (or more)
  4. 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.

Complete form


You can also report an adverse drug reaction:
– by email to
– 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.