Address a medical inquiry

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Who are you ? *

(Please select your profile)

Member of public (yourself, a patient, a friend, a parent)

Health professionnal (a doctor, a pharmacist, a nurse)

The profile field is required

What is your email address ? * Invalid email address (e.g. exemple@mail.com)

Is reporter the patient ?

Yes

Someone I know

A patient I support

Could you please specify his identity ?

Can we contact you if we need more information about your

Yes, you can contact me

No, you cannot contact me

What are your contact details ?

Please specify your phone number or your postal address

What is your profession?

Please specify your profession

Product 1

What is the name of the Biocodex product suspected ? * The product field 1 is required

Why the Biocodex product is used?

Do you know the batch number of the Biocodex product ? If yes, please specify

You can find this number on the packaging of the product

Do you know the expiration date of the Biocodex product? If yes, please specify.

You can find this date on the packaging of the product

Do you consider other product as suspect ?

Yes

What is the patient’s gender ? *

The patient is the person who experiencing the adverse event

Male

Female

Unknown

The patient's gender field is required

Is the patient pregnant ?

Yes

Unknown

What are the patient's initials ?

First letter of first name and first letter of last name

What is the patient’s date of birth ?

Unknown

How old is the patient ?

Unknown

What is the patient’s age group ?

Can you explain your request please? * The request field is required

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Please read and accept our RGPD policy in order to send your submission :

Personal data can be processed, in respect of medical confidentiality, to allow BIOCODEX to follow up the requests for information or quality complaints on the products and to meet its legal obligations in pharmacovigilance, which aims to monitor the risk of adverse reactions resulting from the use of drugs it sells. These data are accessible only to BIOCODEX members and authorized services, and are not intended to be transmitted to other companies or organizations. These data will be kept up to 10 years after the end of the marketing of the product. In accordance with the (EU) General Data Protection Regulation 2016/679 of 27 April 2016 (« GDPR ») on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, you can exercise your right of access to the data concerning you and rectify them, by contacting the Data Protection Officer (« DPO »): dpo@biocodex.com | DPO BIOCODEX – 22 Rue des Aqueducs – 94250 GENTILLY – France . If you are a healthcare professional, be sure to communicate orally to the patient the above mentioned information and inform him that his right to access and correct the data could be exercised only through you, as BIOCODEX has no access to his identity.

I have read and I agree with Biocodex’s terms of use and privacy statement *

You must accept the terms of use to submit your case.

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Address a medical inquiry

Address a medical inquiry

Product 1

Product __ID__

Product ID