Report a potential product complaint

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Product Selection

In order to keep patients safe, it is vital that the highest possible quality is maintained with our products. If you suspect a potential defect or a Roche product has not met your expectations, please report this to us and provide as much information as possible.

For which Roche product do you have a complaint?

Roche product*

Enter name of defective Roche product

Do you suspect a product falsification?

Yes

Product Information

Please provide as many details about your product as possible. Refer to the diagram on the right side to find where the requested information is typically found.

Product Information

Product selected

Complaint Details

Please describe the defect in as much detail as you can. If possible, please also upload a photo of the product and defect.

Complaint Details

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

Add defect description*

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)

When was the defect observed?*

Photo Upload

Please support the investigation process by attaching multiple photos of the defect(s) and its packaging from all sides.

Upload files

Max files: 15
Max overall size 20 MB
Permissible file types: .png, .gif, .jpg, .bmp, .pdf

Photo Upload

Complaint Details Continued

Please answer the following questions to the best of your knowledge.

How was the product stored?

In the original packaging

At room temperature

In the fridge

In the freezer

I don’t know

How long have you/patient been using the product?

New to product

Familiar with product

I don’t know

Was the product administered at home or in a medical environment (e.g. hospital/clinic)?

At home

Medical environment

I don’t know

Please provide the date of complaint occurrence:

Was there a delay in administration of the product as a result of this complaint?

Yes

I don’t know

Did the administrator of the product receive any handling training?

Yes – via watching a video

Yes – via medical staff demonstration

Yes – via Roche programs

Yes – via verbal instructions

Yes – via reading the Patient Information Leaflet

Yes – other

I don’t know

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

Yes

I don’t know

Have there been any side effects involved?

Yes

I don’t know

Personal Details

Are you a…

Patient or Caregiver

Healthcare Professional (e.g. Physician, Pharmacist, Nurse)

Roche Global Partner

Other (e.g. wholesaler)

Choose salutation

Salutation

Choose salutation

Enter first name

First name*

Enter first name

Enter surname

Surname*

Enter surname

Enter a valid email address to contact you

Email address*

Enter a valid email address to contact you

To allow for timely communication if needed

Telephone number

To allow for timely communication if needed

Enter the name of your organisation

Institution / Organisation*

Enter the name of your organisation

Enter the address of your organisation

Address of institution / organisation*

Enter the address of your organisation

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

Yes

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 your 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.

Roche (Philippines) Inc. ("Roche") is required by law to record and/or report adverse events. Therefore, your data will be processed for these purposes in accordance with the specific GVP (pharmacovigilance) legislation, as further described in the Roche Privacy Notice for Pharmacovigilance, Medical Information and Product Complaints.

Roche will retain the personal information you provide for the purposes of responding to your request, following up on such requests, retaining the information in Roche's global pharmacovigilance database for reference purposes and to comply with our legal and regulatory record-keeping and reporting obligations. The retention period of the data is in accordance with the relevant laws and regulations.

By including personal data of another data subject in the form, you declare the lawfulness of the processing of this personal data.

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

Product Selection

For which Roche product do you have a complaint?

Do you suspect a product falsification?

Product Information

Product selected

Complaint Details

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)

Photo Upload

Complaint Details Continued

How was the product stored?

How long have you/patient been using the product?

Was the product administered at home or in a medical environment (e.g. hospital/clinic)?

Please provide the date of complaint occurrence:

Was there a delay in administration of the product as a result of this complaint?

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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