Contact Information
Email
Phone Number
Report Data
Report Type
lotion quality
Side effect/drug effect
Side effects of cosmetic products
medication errors
Lotion type
medicine
Vaccine (vaccine)
herbal preparation
cosmetic
diagnostic
Other
Product Name
Factory name / agent name
Registration number
Company Nationality
Batch Number
Age
Description of the report / medication error
Attached file (PDF, IMG)
Product User (optional)
Full Name
length (cm)
Weight (kg)
medical file number