Side-effect reporting form
If you wish to advise Actelion of any side-effects that takes place, please do not hesitate to use this form.
An adverse event is defined as any untoward medical occurrence in a patient or clinical investigation subject administered a pharmaceutical product. This untoward medical occurrence does not necessarily imply a causal relationship with the particular treatment and includes the following:
- Lack of efficacy
- Suspected transmission of an infectious agent via a product
- Overdose, misuse or medication errors
- Pregnancy/lactation when using a product (whether or not associated with an adverse event)
- Drug-drug interactions
FORM FOR PATIENTS
The fields marked with a * are mandatory.