Report a potential product defect

Are you a…

If permitted by local regulations, do you want to be informed about the outcome of the complaint investigation?

Roche Servicios S.A. ("Roche") has legal obligations to record and/or report product complaints. Therefore, for such purposes your data will be processed in accordance with specific drug safety legislation, as further described in the Roche Privacy Notice for Pharmacovigilance, medical information and product complaints.

Roche will keep a record of the personal data that you provide for the purpose of responding to your inquiry, to follow up on such requests, to maintain the information in the Roche product complaint database for reference and to comply with our legal and regulatory recording and reporting obligations. The retention time of data is in accordance with respective laws and regulations.

By including personal data of another data subject in the form, you represent the lawfulness of processing of such personal data.

The Privacy Policy provides further detailed information about your rights and how Roche processes personal data.

Country of residence / practice

Product Selection

For which Roche product do you have a complaint?

Do you suspect a product falsification?*

Product Information

Product selected

Please select the procedure to which your concern relates:*

Please select your product type (dosage form).*

Is your product available for return?

Complaint Details

What exactly is wrong with your Roche product? Upload photos of the defect.

How is it different from "normal"? Please add a detailed description of the defect (e.g. appearance, damage, leakage).

Describe at what point was the defect or issue discovered (e.g. when opening the box, before the administration, after the administration, at which handling step according to instructions of use or patient information leaflet)

Complaint Details Continued

How was the product stored?*

How long have you/patient/caregiver been using the product?*

Was the product administered at home or in a medical environment (e.g. doctors office)?*

By whom?

Did the administrator of the product receive any handling training?*

Has this complaint also been reported via an additional channel (e.g. Health Authority / Call center/ Pharmacy)? *

Have there been any side effects involved?*

Personal Details

Are you a…

If permitted by local regulations, do you want to be informed about the outcome of the complaint investigation?

Country of residence / practice

Product Selection

For which Roche product do you have a complaint?

Do you suspect a product falsification?*

Product Information

Product selected

Please select the procedure to which your concern relates:*

Please select your product type (dosage form).*

Is your product available for return?

Complaint Details

What exactly is wrong with your Roche product? Upload photos of the defect.

How is it different from "normal"? Please add a detailed description of the defect (e.g. appearance, damage, leakage).

Describe at what point was the defect or issue discovered (e.g. when opening the box, before the administration, after the administration, at which handling step according to instructions of use or patient information leaflet)

Complaint Details Continued

How was the product stored?*

How long have you/patient/caregiver been using the product?*

Was the product administered at home or in a medical environment (e.g. doctors office)?*

By whom?

Did the administrator of the product receive any handling training?*

Has this complaint also been reported via an additional channel (e.g. Health Authority / Call center/ Pharmacy)? *

Have there been any side effects involved?*

Personal Details

Are you a…

If permitted by local regulations, do you want to be informed about the outcome of the complaint investigation?

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