Reporting Adverse Events

Like all medicines, this medicine can cause side effects, although not everybody experiences them.

If you experience any side effects, talk to your doctor or healthcare professional
Infloran presents no known side effects when used at the recommended dose.
By reporting any side effects, you can help provide more information on the safety of this medicine.

The safe use of medication is always our priority and the collection of information from any undesirable effects is important to help maintain the safe use of medications.
You can assist us by completing the details within the below form.

The information supplied remains confidential unless requested by the relevant government health authorities, the Therapeutic Goods Administration (TGA)

Patient Details

Name

Initials

Age

Gender

Height

Weight

Ethnicity

Relevant Identifier

Age Category

Date of Birth

Concomitant Conditions

Patient’s medical history including relevant past medicine history

Relevant family history

Details of the Suspected Medicine(s)

Brand Name as reported

Active ingredient Batch or Lot number

Dosage form and strength

Administration Route

Starting Date and Time

Medicine Label

Indication(s) for which suspect medicine was prescribed or tested

Daily dose in units e.g. mg, ml, mg/kg and regimen

Administration Site

Stopping Date and Time or Duration of Treatment

Details of the Adverse Reaction(s)

A full description of the reaction(s), including body site and severity

Changes to medicine administration e.g. medicine withdrawn, dose reduced, dose increased, dose not changed, unknown or not applicable

Any additional relevant information on medicine

If the reaction is suspected to be the result of an interaction with alcohol, food or another medicine, the names and active ingredients of the suspected interacting medicines or substances.

Contact Information

Phone Number (optional)