1. Reporter Details

You are completing this report as a Healthcare professional

Thank you for choosing to report a suspected adverse reaction to the Yellow Card Scheme. The information that you provide can help us in our work to identify previously unrecognised side effects, and thereby improve the safe use of medicines. We will use the email address provided below for future correspondence about this report, however if this is not given then we will correspond using the postal address provided.

Fields that you must complete are marked with this symbol: Required

Help

If you are a healthcare professional we ask for your occupation as this helps us to have a better understanding of the case.

Contact Method

Contact Method

Please provide a postal address, email address or both.

Address

Address

Telephone Number

Telephone Number

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Privacy Policy

Form actions Step 1. Reporter Details