Medical Enquiry or to Report a Suspected Side Effect form (UK14WEB0011a(2) DoP: August 2016)

 

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.

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 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
Servier is committed to protecting your privacy. If you submit an enquiry, we shall use your personal information (e.g. name, address, telephone number and email address) to respond to your enquiry. All the information and personal data you share with the Company in your enquiry will be securely stored and kept confidential in line with the Data Protection Act 1998. The information you provide may be used for the purpose of drug safety surveillance and will enable the Company to deal with your enquiry appropriately. If applicable, the information you provide may also be forwarded to the medicines regulatory authorities in the European Union. We do not share any of your personally identifiable information with third parties unless we are required by law to do so, or in support of any legal or criminal investigation. You may request at any time to access the personal information that Servier holds about you. You may also ask for this information to be updated or corrected if needed. If you have any questions relating to your personal information please contact us at: datamanagement@uk.netgrs.com. Requests to delete personal data will be subject to any legal and ethical reporting or document filing or retention obligations imposed on us. By using the Site, you agree to these conditions.
Image CAPTCHA
Enter the characters shown in the image.