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Reporter Type

Reporter Type
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If you are reporting about your own suspected reactions to a medicine and you are a healthcare professional, please fill in the 'reporter type' as healthcare professional.

Contact Email

Please note this email address has previously been registered with the Yellow Card site, you can login here. Logging in will save you time and you can then keep a track of submitted reports.

Please provide an email address to receive notifications about your submission.

1. Reporter Details

We are sorry to hear that you or someone that you know has had a side effect to the medicine they were taking. The information that you provide when you report the experience to us can help us in our work to identify previously unrecognised side effects, and thereby improve the safe use of medicines.

We would appreciate if you could please provide your contact details below so we can follow up for further information about your report if necessary.

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

Contact Method

Contact Method

Address

Address

Telephone Number

Telephone Number

Form actions Step 1. Reporter Details