Adverse Event & Product Complaint Reporting form

If you are reporting a product complaint please retain the complaint sample in the same storage conditions for further investigations.

Alternatively to report an adverse event, you can call us on +(971) 5444-09415

 

Please enter the date you were aware of the adverse event or product complaint (date format: DD/MM/RRRR)
When did the adverse event or product complaint occur? (date format: DD/MM/RRRR)

2000 characters left

2000 characters left

Secondary Reporter (if applicable)

*Disclaimer: By submitting this form you are aware that Roche has legal obligation to collect and report potential adverse events brought to its attention to Health Authorities. In such cases, your data will be processed with greatest care and diligence in accordance with specific GVP (pharmacovigilance) legislation, as described in the Privacy Policy related to pharmacovigilance [https://www.roche.com/privacy-notice-pv-mi.htm]. Your data will not be used for any other purpose.