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Please specify your phone number or your postal address Please specify his/her phone number or his/her postal address You can find this number on the packaging of the product Name, start and discontinuation dates of products used in the past and products ongoing First letter of first name and first letter of last name It could be past or concomitant pathologies; for example, diabetes, arterial hypertension, allergies etc If you have more information and details about the adverse event you can mention in this box Do not provide any patient identifiable information (name, date of birth) in this box The patient is the person who experiencing the adverse event form-adverse-event-adverse-batch-number-information You can find this date on the packaging of the product form-adverse-event-adverse-indicate-label-information Add more