Information on the mother
Information about the notifying person
Medical and gynaecological-obstetric history
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Information on termination of pregnancy
Natural childbirth Caesarean section Intervention delivery Miscarriage Termination of pregnancy
[group przerwanie]
Was the abortion recommended by a doctor? YES NO
[group przerwanie_zalecane]
Intrauterine fetal demise Timely birth Pre-term birth Not specified [/group]
[/group]
Information concerning the child
Apgar score:
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If an event (maternal, foetal, neonatal) has occurred, is there a reasonable possibility that it may have been caused by the medicine(s) used during pregnancy?
NO YES
[group zdarzenie_leki] [/group]
Medicines used during pregnancy
Personal data processing
The administrator of the personal data included in the form is Farmak International spółka z ograniczoną odpowiedzialnością, 22 Jana Pawła II Avenue, 00-133 Warsaw. Your personal data is processed on the basis of Article 6(1)(c) and Article 9(2)(i) of the General Data Protection Regulation (RODO, EU 2016/679 of 27 April 2016). The personal data provided are processed solely for the purpose of fulfilling the obligations of monitoring the safety of use of medicinal products in accordance with Regulation (EU) No 520/2012 of 19 June 2012. The provision of the data of the notifier is necessary for the acceptance of the notification. The recipients of your personal data will only be entities authorised to obtain personal data under the law. You have the right to access and correct your data. Your personal data will be stored for the entire period of marketing authorisation of the medicine and for 10 years after the expiry of the authorisation. You have the right to lodge a complaint with the President of the Office for Personal Data Protection if you consider that the processing of personal data concerning you violates the provisions of the RODO.
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