Paraking Syrup 100ml

Consumer Reporting Form

We are sorry that you or someone that you know has had a reaction to the medicine they were taking. Information you provide when you report adverse drug reaction (side effect) can improve the safe use of medicines. Please provide your contact details below so we can follow up for further information about your report if necessary. You can report on side effects, drug ineffectiveness, product quality, suspected counterfeit or medical device defect, medication error (i.e. mistake made in the prescription, dosing, dispensing or administration of the medicine).

REPORTER DETAILS

About you the person making the report

First Name

Surname

Telephone

Email

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WHO EXPERIENCED THE SIDE EFFECT?

Select your relationship with the affected person

Name or Initials

Gender

Message

Paraking Syrup 100ml

Description

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Consumer Reporting Form

REPORTER DETAILS

About you the person making the report

WHO EXPERIENCED THE SIDE EFFECT?