Adverse Event / Complaint Reporting Form
Adverse Drug Reactions/Side effects can also be submitted using the telephone number/email below.
Tel.: + 44(0) 208 901 3370
Email - firstname.lastname@example.org
* Mandatory field
All the information including personal and sensitive data you share with us will be protected and kept confidential in line with FLAMINGO PHARMA, UK Limited’s SOP and applicable local regulations.
The information you provide will be used for the purpose of drug safety surveillance and will enable us to deal with your enquiry appropriately. Your personal (including but not limited to sensitive personal data) may also be transferred to third parties who act for or on our behalf, for further processing in accordance with the purpose(s) for which the data were originally collected. We may also disclose this information as required by law or regulation to The Health Authorities in the country, and other countries around the world.
By submitting this form, you also expressly consent to the transfer of your personal data (including but not limited to sensitive personal data) and the processing of such data outside the European Economic Area (“EEA”). When personal data is transferred outside the EEA, special safeguards are foreseen to ensure that the protection travels with the data.
At any time and subject to applicable laws, you have the rights of access, rectification, cancellation, opposition, revoke your consent to use, disclose, transfer and process of your personal data.