General questions

Tel number: +49 (0)89 4518748 - 0
Fax number: +49 (0)89 4518 748 - 20
e-mail: info.de@amaroxpharma.com

Pharmacovigilance notification

If your request relates to an adverse event (or side effect) that occurred in connection with the use of one of our products, please send your report to:
Tel number : +49 (0) 89 4518748 - 28
Fax number : +49 (0) 89 4518 748 - 20
E-Mail : safety@amaroxpharma.com

We treat all information as strictly confidential and in accordance with the statutory data protection guidelines.

Our team is always available to answer your questions.

    SIDE EFFECT REPORTING FORM

      Reporter Details

      Initials

      Healthcare ProfessionalPatientRelative

      Patient Initials

      Product 1

      Product 2

      Product 3

      Product 4

      Suspected relation with

      Product 1Product 2Product 3Product 4

      Taken Earlier

      YesNo

      Tolerated

      YesNo

      Possibility Reexposition

      Neg.Pos.

      Anamnestic characteristics

      NicotineAlcoholContraceptivesPacemakerImplantsRadiotherapyPhysic TherapyDietAllergiesMetabolic DefectsMedicine abuseOthers

      Life Threatening

      YesNo

      Outcome of the adverse drug reaction

      RecoveredPermanent DamageNot Yet RecoveredUnknownExitus

      Section

      YesNo

      Attach findings if applicable