Medicines

Report a Side Effect

Report a
Side Effect

Biogen has a regulatory responsibility to continually assess and communicate the benefit/risk profile of our products to patients, healthcare professionals and regulators. To meet this obligation, we may need to contact you to obtain further details regarding the side effects reported.

Use the form below to report a side effect

If you prefer, you may contact the U.S. Food & Drug Administration (FDA) directly www.fda.gov/Safety/MedWatch or call 1-800-FDA-1088.

Reporter and Contact Information

Please provide your information

Your location*

Title

First name*

Last name*

Which best describes you?*

Do you give Biogen consent to contact you about this report?*

Yes

Please provide your contact details (full address, phone number, email address or fax number)?*

Do you give Biogen consent to contact your healthcare professional if we need more information about your report?*

Yes

What is your healthcare professional’s name?*

What are their profession, contact details (full address, phone number, email address or fax number)?*

Do you give Biogen consent to contact you about this report?*

Yes

Please provide your contact details (full address, phone number, email address or fax number)?*

Do you give Biogen consent to contact you about this report?*

Yes

Please provide your contact details (full address, phone number, email address or fax number)?*

Patient Information*

Please provide information on the person experiencing the side effect

Patient initials

Gender at birth

Male

Female

Year of birth

Product

Please provide information on the medication you think may have caused the side effect

Product*

Please provide any additional information on the medication

Side effect

Please provide information on the side effects you are reporting

Describe the event*

When did the event start?

Have you/has the patient recovered from the event?*

Not recovered

Recovered

Still recovering

Unknown

When did the event stop?

Did the event result in any of the following?*

Hospitalization

Prolongation of existing hospitalization

Life threatening illness (immediate risk of death from the event)

Disability or permanent damage

Patient died

Congenital anomaly or birth defect

None of the above

Additional Relevant Medical Information

If applicable, please provide results of tests/labs, medical history, other diagnosed illnesses, allergies, etc.

This report of side effects, contact details and the personal information provided shall be handled by Biogen in accordance with Biogen's Privacy Policy.

I acknowledge Biogen's Privacy Policy*

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Report a Side Effect