Pharmacovigilance

If you believe that you have experienced an adverse event or lack of efficacy with an Alpen Pharma product, please let us know using the form below

Name; Surname
(voluntary)

Can we contact you if we have further questions about the reported adverse event?
NoYes

Initials of patient

Age

Gender

Product dose

Duration for use

Reason for use

Lot no. or best before date

Please choose the option

Please describe what has happened
*Please include the timing in relation to the intake of the product

Please write how does the patient feel now. Has the event resolved?

Are there relevant concomitant/pre-existing conditions?

Are any additional medicinal products being used, please specify which one?

Was a doctor consulted after the adverse event occurred?

You can attach a file here, e.g. photograph