Report a side effect

At Profarma, your health and safety matter.

If you experience any side effects while using one of our medicines, please let us know by reporting them to us so we can take prompt action. Your report helps us continuously monitor and ensure the safety, quality, and proper use of our products.

You may contact us at: drug.safety@profarma.al

Alternatively, you can use the reporting form below to submit details about the adverse event.

All reports are treated confidentially and handled in full compliance with applicable pharmacovigilance and data protection requirements.

REPORTER INFORMATION

Are you reporting as:

Patient Healthcare Professional Pharmacist Other

Email address

Phone number

PATIENT INFORMATION

Patient Name & Surname / Initials

Patient age

Patient gender*

Female Male Other Prefer not to say

SUSPECTED MEDICINAL PRODUCT

Product name

If you are unsure, please provide as much detail as possible

Dosage / strength

Start date of use

Stop date of use

ADVERSE EVENT

Describe the side effect

Date when the side effect started

EVENT OUTCOME

What is the outcome?

SERIOUSNESS

Did the event result in:

ADDITIONAL INFORMATION (OPTIONAL)

Other medicines taken at the same time

Relevant medical history

Action taken with the product

Stopped Dose reduced No change Unknown

ATTACHMENTS (OPTIONAL)

Upload supporting documents

CONSENT

I confirm that the information provided is accurate to the best of my knowledge

I consent to the processing of my personal data for pharmacovigilance purposes in accordance with applicable data protection laws