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Privacy notice for reporting human medicines adverse reactions

The HPRA operates the national system for recording and reporting details of suspected adverse reactions occurring in Ireland. Please see full details of how personal data is processed in this area.

Human Medicines Adverse Reaction Report

IN CONFIDENCE

Fields marked with an asterisk (*) are mandatory.

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Reporter Information
Patient Information
Suspect Drug Information
Suspected Reaction
Outcome
Photos & Files
Preview & Submit

Reporter Information

Title: *

First Name: *

Surname: *

Organisation:

Department:

Address 1: *

Address 2:

Address 3:

City:

County:

Country:

Telephone:

Mobile:

Email: *

Confirm Email: *

Reporter Type:

Other:

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