Reporting of Suspected Adverse Drug Reactions

Dear Healthcare Professionals,
Dear Patients,

Please notify us of any suspected adverse drug reactions observed during the use of medicinal products of "ECOPHARM GROUP AD" or distributed by "ECOPHARM" Ltd. by completing this form.
The information you provide will be treated as confidential and processed in accordance with all applicable confidentiality principles. Your contact details are required so that we can confirm receipt of your report, contact you if additional information is needed, and inform you about the measures taken.
Please submit a report even if you do not have all the necessary information. Every detail you provide is of significant importance to us.

You may also report adverse reactions using the following contact details:
Phone: +359 2 906 90 78
Email: pv@ecopharm.bg

Please complete the mandatory fields (*).

Patient Information


Adverse Drug Reaction


Suspected Medicinal Product 1


Suspected Medicinal Product 2

Other Medicinal Products (Concomitant Therapy)

Medicinal Product 1

Medicinal Product 2

Medicinal Product 3


The adverse reaction resulted in:

Outcome of the adverse reaction:

Re-exposure

Causality Assessment


Additional Information


Reporter Information *