Report an adverse reaction

Notification of side effect

Side effect of a medicinal product is understood as each adverse and unintentional effect of the product.

Przedsiębiorstwo Farmaceutyczne LEK-AM Sp. z o.o. collects all information referring to the safety of its medicinal products, registers and monitors it. Such an attitude results from our interest in a patient’s health and safety as well as care for the conformance of our activities with relevant Polish and European law regulations.

We request for notifying us about any observed side effect of a medicine and information of the safety of using a medicinal product from LEK-AM’s portfolio:

By mail: print the form, complete it and send to:

Przedsiębiorstwo Farmaceutyczne LEK-AM Sp. z o.o.

Aleja Jana Pawła II 80, 00-175 Warsaw

e-mail: pharmacovigilance@lekam.pl

By fax: print the form, complete it and send to:

+48 22 4644572

In the event of any doubts about notifying side effects, please contact us at +48 22 46 44 570

You can also report any side effects directly on the site using the form below.

Product *

Details of reporting person
please provide your full name and contact details (e.g. phone/e-mail/address)

First name *

Last name *

Phone No.

Postal address

Patient information
please give the patient's initials, gender and/or age

Gender

Age

Initials *

Description of the event *

Date of occurrence

Description of the event *

Date symptoms stopped

(if applicable)

Current state of patient's health

Other drugs or medical devices and dietary supplements used

(including when use began)

Additional information on the state of the patient's health

(e.g. past medical history, chronic illnesses, allergies)

I confirm that I have familiarised myself with the privacy policy. *

We will review your submission and a LEK-AM representative may contact you for additional information.

* mandatory fields

Report an adverse reaction

Details of reporting person please provide your full name and contact details (e.g. phone/e-mail/address)

Patient information please give the patient's initials, gender and/or age

Description of the event *

Details of reporting person
please provide your full name and contact details (e.g. phone/e-mail/address)

Patient information
please give the patient's initials, gender and/or age