Report adverse reaction

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Dr. Romana Skálová

  • The qualified person responsible for pharmacovigilance
    E-mail: export@walmark.cz
    Tel.: +420 234 709 851
    Walmark, a.s.

1. Information about the person that experienced the adverse drug reaction:


In the interest of objective evaluation of your report on suspected adverse reaction, please leave your contact details and you will be immediately contacted by our expert.


Fill in one of the three following data at least (the data will not be associated with the case report above, it is used only for follow up contact of our expert to identify any additional information).


2. Information about the suspect drug (drug which caused an adverse reaction)


3. Information on the progress of the adverse drug reaction:


Walmark, a.s.

  • Oldřichovice 44, 739 61 Třinec, Česká republika,
    VAT: CZ699003348
Walmark

Contact information: