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Privacy notice for Suspected Medicinal Product Quality Defect Form

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.

Please note that the online form below is for use by patients and healthcare professionals. If you are reporting on behalf of a marketing authorisation holder, manufacturer or wholesaler, please use this form.

Suspected Medicinal Product Quality Defect Form

Fields marked with an asterisk (*) are mandatory.

To move through the steps of the form please use the Next and Previous buttons that are at the bottom of the form.

Reporter Information
Defect Information
Photos & Files
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Reporter Information

Title: *

First Name: *

Surname: *

Organisation:

Department:

Address 1: *

Address 2:

Address 3:

City:

County:

Country:

Telephone: *

Mobile:

Email: *

Confirm Email: *

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