Completing a Report

We want you to understand what The Reaction Registry is and what it will do. We will provide a way for you to file an effective report to an unexpected reaction to a medicinal product. We will send your report to the relevant manufacturer and to the appropriate government agency. We will also retain a copy of your report for further scientific and medical analysis.

1. In order for you to make a report we ask for your name, address, telephone number and email address.
2. All information that could identify you (e.g. name, address, telephone number, email) is kept in a encrypted database, separate from the information that you give about reactions. For details please read our Privacy Policy.
3. You will be asked for information of a personal nature (e.g. your height and weight), but this information is anonymous. It is needed for statistical analysis, and the more that is collected, the more accurate will be the inferences and conclusions that are drawn from the data.

Please read our Privacy Policy. When you have accepted the terms you may apply to create a report.

I have not read the Privacy Policy

I understand that The Reaction Registry is dedicated to the furthering of Medical and Scientific Research. The object of the registry is to collect information that will help in this research. I voluntarily agree to give information that may help in this endeavour. I understand that detailed epidemiological information, e.g. details of life style (foods eaten, drinking habits, smoking habits, etc), allergies and medications used, will contribute to the furthering of medical research and scientific understanding.