Drug Safety
If you would like to report a side effect or quality complaint, please contact us on email by submitting the drug safety report form in the below button. By submission of the form our team will contact you. Alternatively, you may like to contact either your health care professional or local health authority to fill and submit the safety report form in the below button.
Contact Options
Level 42, 600 Bourke Street,
Melbourne, 3000, VIC, Australia
Tel (only within Australia): 1300 117 772
Tel (outside Australia) (+61) 3 7040 8187

Fill the form to contact us directly

    Drug Safety Report Form

      Patient Information

      Identities of reporter and patient will remain strictly confidential

      Patient Full Name:

      Age of Patient:

      Patient Weight:

      Please enter a number from 30 to 200.

      Adverse Reaction / Product Quality Problem

      Date of onset of reaction:

      Time of onset of reaction:

      Description of reaction or problem (Include relevant tests/lab data, including dates):


      Date Stopped:

      Date Started:

      Adverse Reaction Outcome

      Check all that apply:

      Other Outcomes:

      Reaction abated after stopping medicine:

      Event reappeared on rechallenge: