This report should be completed when a suspected adverse event or lack of efficacy is suspected in animals or humans during, or after the use of one of Norbrook’s Veterinary Medicines. Upon receipt of this report, a member of the Pharmacovigilance department will contact with the reporter to investigate the event. The contact details of the reporter will be treated as confidential and will not be passed to anyone outside of Norbrook without permission.

Contact Information of the Reporter

Type

Other

Reporter Name

Reporter Address

Contact Tel. No.

Email address

Details of Product Administered and Animals Involved in the Adverse Event(s)

Name of Product

Batch Number (on label)

Species Involved

Other Species

Nature of Reaction / Lack of Efficacy

Any additional information, if available

Please forward this form to Norbrook as soon as possible and one of the Pharmacovigilance team will be in touch.

Pharmacovigilance Adverse Event Reporting Form

Contact Information of the Reporter

Details of Product Administered and Animals Involved in the Adverse Event(s)