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  • Current Preliminary information
  • Reporter/enquirer details
  • Product information
  • Adverse event information

Vifor Pharma takes the safety of patients very seriously. Reporting an adverse event allows us to continuously monitor the safety of our products.

To help us process your report quickly and effectively, fill out the form below with as much relevant information as possible to report an adverse event for a Vifor Pharma product.

Data privacy

In order to respond to your enquiry it is necessary to collect some personal information such as your name and contact details. If you have queries concerning personal data or data privacy, please see our data privacy policy.

Preliminary information

Personal information

*Mandatory field

Reporter/enquirer details

Personal information

Contact information

Address

*Mandatory field

Product information

Product details

*Mandatory field

Adverse event information

Adverse event or special situation

Please provide the adverse event term in your local language. You may report up to six adverse events. Please include one term per field.

Adverse event terms

Narrative

Describe the event and provide any relevant additional information that you wish to include in your local language.

Case seriousness

Assessment should always be done by a health care professional.

Patient details

If known, please provide the patient's date of birth only, if unknown, you may provide either the patient's age or age group.

Additional comments

Data privacy

In order to respond to your enquiry it is necessary to collect some personal information such as your name and contact details. If you have queries concerning personal data or data privacy, please see our data privacy policy

Have you informed the reporter/enquirer about Data Privacy Notice?
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*Mandatory field

Data privacy

The personal data provided on this form will be stored and used by Vifor Pharma Management Ltd., Flughofstrasse 61, 8152 Glattbrugg, Switzerland and/or its affiliates (“Vifor Pharma”) and their service providers and collaboration partners to process the unsolicited request for medical information and respond to it.

After responding to the request, they could use the content of the unsolicited request and the response to it for medical information purposes on an anonymized basis.

If the enquiry contains safety information, Vifor Pharma is required by law to forward it to its drug safety department for processing and reporting to health authorities. That department will receive the reporter details to document the source and for follow-up purposes.

If you would like to receive a copy of our Privacy Notice please send an e-mail to: groupdpo@viforpharma.com.

Authorisation

I hereby certify that this is an unsolicited request, initiated by myself and completely independent of Vifor Pharma Group, and that I am a healthcare professional licensed to prescribe, purchase, supply, recommend or administer medicinal products.