The information you provide us is extremely important to detect unknown adverse reactions to medicinal products authorized for use on the territory of the Republic of Bulgaria.
We will need your contact details in order to feedback to confirm receipt of the message; If we need to request additional information and to inform you of the measures taken.
We assure you that the personal data of reporter / patient is treated in accordance with the Law on Personal Data Protection.
The BDA is registered as a data controller under the law. Certificate №0026870.
Please notice that some fields marked with (*) are mandatory to fill in order to submit a valid report form.
Nevertheless we would like to encourage you to provide as much information as possible, because it is important for the assessment of your report.
* Please provide contact details by completing at least one of the fields in order to submit a valid report; preferably - phone number.
* Complete at least one of the fields to be accepted as a valid report.
1. Drug formulation (e.g. tablets), dose unit (e.g. 250 mg):
2. Pharmaceutical company - marketing authorization holder:
3. Batch number:
4. Reason for taking the drug:
5. Dose regimen. When (at what time), how many times per day; per hour; per week?
7. End date:
Additional information about the medicinal product:
Other drugs taken during the adverse reaction:
Quality and Information Security Policy
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