Dear patients, medical doctors and pharmacists,
By filling in this form, you will provide us with information, which is essential for discovering and monitoring of unknown adverse reactions to medicinal products (ADRs), authorized to be marketed in the territory of Bulgaria.
It is necessary to fill in your contact details in the form, in order for us to provide you with feedback, as well as to confirm that we have received the message sent by you to us. In this way we can contact you to request additional information, as well as to inform you about the measures, undertaken by us, related to unknown adverse reactions to some of the medicinal products. Your personal data are treated, according to General Data Protection Regulation (GDPR) and the Personal Data Protection Act (PDPA), in which you can be assured.
In order for us to evaluate your message, as well as to undertake the most reasonable measures after your report of unknown adverse drug reaction, it is necessary to fill in as much data as possible in the report form.
You can fill in this form by downloading it and printing it. After you fill in the form, please send us scanned copy to the following e-mail address: firstname.lastname@example.org. As soon as we receive your message with the form attached to it, we will contact you to confirm the receipt of the message with the form enclosed, as well as to clarify the actions that we will undertake after the evaluation of your message.
Thank you for your collaboration!
7 Sheinovo Str.
Tel.: +359 2 987 95 37
We would like to inform you that by reporting unknown adverse reaction to INBIOTECH, Ltd., you will share personal data, which we should process and store for long term, according to the law on the medicinal products in human medicine (LMPHM). We will use your data for tracking, analysis and reporting purposes, related to the medicinal product safety. Please, read more about your personal data protection here.