Country of residence / practice
Please confirm your Country of residence / practice on order to route your request to the responsible locale team.
当您填写问询和个人信息时，请注意以下要求：
姓名请提供姓名首字母缩写
工作单位请勿提供军警院校、党政军或涉密单位的信息
请勿提供具体的地址信息
此外，请勿提供任何与生日，民族相关的个人信息
Please note the following requirements when filling out inquiries and personal information:
For the name, please provide initials only.
Do not provide information from military, police institutions, party or government offices, or confidential units as your workplace.
Do not provide specific address information.
Additionally, do not provide any personal information related to birthdays or ethnicity.
Who is contacting us?
A temperature excursion or breach is defined as storage or exposure of a Roche product outside the labelled storage temperatures for any length of time.
Are you a…
Temperature Excursion Details
Definition:
A temperature excursion or breach is defined as storage or exposure of a Roche product outside the labelled storage temperatures for any length of time.
Please provide details of the temperature excursion but do not provide any personal data (including sensitive personal data). To enable an accurate assessment, it is important that the time and temperature data you have provided are both complete and accurate. You will be able to add the affected products on the next page.
Specify recorded temperature(s) excursion (one value is mandatory)
Duration below lower limit
Duration above upper limit
How many times did the temperature drop below 0.5ºC and came back up to 0.5ºC?
Any other details?
Attach your fridge log sheet (optional)
Product Information
Additional products? ({{form.products[index].index}})
Please provide information on the affected products. You can add multiple products by using the “Add Product” button at bottom of this page.
Which products were affected in the reported excursion?
Do you have a patient waiting for the product?
Has the product been involved in a previous temperature excursion while in your possession?
Has the product been reconstituted/diluted?
Is the product at its final storage location before being administered /dispensed /supplied to the patient?
Has the product been administered to the patient?
Products affected by the reported excursion
{{product.product.label}}
{{product.product}}
Contact Details
Please complete the form by adding your contact details
I consent to my data being processed for the purpose of responding to my inquiry and in accordance with the Roche Privacy Policy & Privacy Notice for Pharmacovigilance
You consent, by ticking the box above, to the processing of your data for the purposes of responding to my inquiry and in accordance with the Roche Privacy Notice for Pharmacovigilance, medical information and product complaints. If you do not consent to the data processing, we will not be able to reply to your message and kindly ask you to use other channels to contact us.
F. Hoffmann-La Roche Ltd ("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 medical information 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 Roche Privacy Policy provides further detailed information about your rights and how Roche processes personal data.
Your report
Which Roche product has been affected? Please provide as much information as possible about the product and event but do not provide any personal data (including sensitive personal data). This information will be sent to the local Roche office who may contact you for further information. You will receive a notification once your case has been assessed. Please ensure that product is correctly stored while waiting to hear back from us.
Product name
Additional Product Details
What happened to the product?
Contact Details
Please complete the form by adding your contact details
I consent to my data being processed for the purpose of responding to my inquiry and in accordance with the Roche Privacy Policy & Privacy Notice for Pharmacovigilance
You consent, by ticking the box above, to the processing of your data for the purposes of responding to my inquiry and in accordance with the Roche Privacy Notice for Pharmacovigilance, medical information and product complaints. If you do not consent to the data processing, we will not be able to reply to your message and kindly ask you to use other channels to contact us.
F. Hoffmann-La Roche Ltd ("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 medical information 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 Roche Privacy Policy provides further detailed information about your rights and how Roche processes personal data.
当您填写问询和个人信息时，请注意以下要求：
姓名请提供姓名首字母缩写
工作单位请勿提供军警院校、党政军或涉密单位的信息
请勿提供具体的地址信息
此外，请勿提供任何与生日，民族相关的个人信息
Please note the following requirements when filling out inquiries and personal information:
For the name, please provide initials only.
Do not provide information from military, police institutions, party or government offices, or confidential units as your workplace.
Do not provide specific address information.
Additionally, do not provide any personal information related to birthdays or ethnicity.