Reporter information What is your country/location? What is your country/location? Select countryAlgeriaAustraliaAustriaBahrainBelgiumBulgariaCanadaChinaCroatiaCyprusCzechiaDenmarkEgyptEstoniaFinlandFranceGermanyGreeceHungaryIcelandIraqIrelandItalyJapanJordanKuwaitLatviaLebanonLibyaLiechtensteinLithuaniaLuxembourgMaltaMoroccoNetherlandsNew ZealandNorwayOmanPolandPortugalQatarRomaniaRussian FederationSaudi ArabiaSlovak RepublicSloveniaSpainSwedenSwitzerlandTunisiaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaMy country is not listed Please enter your location Name First name Last name Phone number E-mail E-mail Confirm e-mail Check if you are a Sobi employee Check if you are a Healthcare Professional Healthcare Professional type Healthcare Professional type - None -DoctorNursePharmacistDentistOther… Enter HCP type… Check if you do not wish to be contacted for any follow-up communication Information about the person who experienced the side effect I am: I am: SelectThe patientA friend/family member/or caregiverOther… Enter other… Patient initials Gender Gender SelectFemaleMaleOther… Enter other… Age at the time of the side effect Information about the medicine Please list the Sobi product which you suspect could have caused the side effect(s). Name of product Product dosage and frequency Describe dosage formulation What was the indication (reason for use)? When did the patient start/stop using this product? Start date End date Unknown dates or ongoing Unknown start date Unknown end date The use of the product is still ongoing Batch/Lot number Side effect description Please list the side effect(s) which you would like to report. Country where event occurred Country where the event occurred Select countryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta & MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSamoaSan MarinoSarkSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkmenistanTurks & Caicos IslandsTuvaluTürkiyeU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Side effect(s) Describe details of the side effect Describe the side effect in more detail, including which impact the side effect had and if any treatment was needed. What date did they first/last experience their symptoms? Symptoms start date Symptoms end date Was the patient hospitalized or did the event cause death? Yes, hospitalized Yes, death No, neither Please upload any relevant documents?