Formulaire

Reporting of an adverse reaction that may be due to a drug or product (Form 10011*07)

Cerfa 10011*07

Any physician, dental surgeon, midwife or pharmacist who has noticed a serious or unexpected adverse reaction likely to be due to a medicinal product, whether prescribed or not dispensed, must immediately report it to the Regional Pharmacovigilance Center.

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    To whom shall I send this form ?

    J'ai réalisé une démarche administrative

    Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

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    Émetteur du formulaire administratif : Ministry of Health

    Verified 08 December 2020 - Directorate for Legal and Administrative Information (Prime Minister)