---
title: "Report an activity"
canonical: "https://uspharmacia.pl/report-an-activity/"
type: "singular"
modified: "2026-09-21T18:02:39+00:00"
published: "2023-04-25T16:15:35+00:00"
---

# Report an activity

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## Hero section

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REPORT SIDE EFFECTS

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We are fully responsible for our medicinal products, so we are committed to reliable information regarding their safety.
We encourage you to report any adverse reactions using the PDF form.

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Go on

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#containers

### Image

https://uspharmacia.pl/wp-content/uploads/2024/01/dzialanie.webp

## Containers section

### Info

Send the downloaded and completed PDF form by e-mail to pv@usp.pl,

and the original by registered mail to: US Pharmacia Sp. z o.o.

Poleczki 35 Street,

02-822 Warsaw IMPORTANT! Write on the envelope: „ADVERSE DRUG REACTION”.

### Containers

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The patient or his/her guardian

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Report an adverse event in yourself or a member of your immediate family.
It can be done by legal or actual guardians and legal representatives of the affected person.

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Download PDF

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https://uspharmacia.pl/wp-content/uploads/2026/09/FZDN-zalacznik-dla-pacjentow-secured.pdf

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Fill out online

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patient

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Medical professional

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Report of an adverse event in a patient.
Form for physicians, dentists, pharmacists, pharmacy technicians, nurses, midwives, laboratory diagnosticians, paramedics, feldspersons (senior feldspersons).

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Download PDF

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https://uspharmacia.pl/wp-content/uploads/2026/09/FZDN-zalacznik-dla-lekarzy-secured.pdf

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Fill out online

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doctor

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Marketing research

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Form intended for individuals who conduct research or participate
in research and wish to report an adverse event.

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Download PDF

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https://uspharmacia.pl/wp-content/uploads/2026/09/FZDN-zalacznik-formularza-badan-marketingowych-secured.pdf

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Fill out online

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research

## Images section

### Title

OTHER WAYS TO REPORT ADVERSE REACTIONS

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https://uspharmacia.pl/wp-content/uploads/2024/01/dzialania1.webp

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We also accept applications by phone.

If you have any questions or concerns, please feel free to contact us:

tel: +48 (22) 543 64 00

or tel: +48 519 031 217

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https://uspharmacia.pl/wp-content/uploads/2024/01/dzialania2.webp

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An adverse reaction can also be reported by contacting the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products

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https://uspharmacia.pl/wp-content/uploads/2025/08/53230368281f45b0b1bbed6b6f20b1db33eabf9c.png

## Important section

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IMPORTANT

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NOTE!

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Please provide as much information as possible as indicated on the form.
To be valid, the report must include at least: patient identification data (initials, age/date of birth, gender) identification data of the reporting person (name, address, telephone) name of the medicinal product suspected of causing the adverse reaction (batch number, if known) description of the adverse reaction.

## Personal data administrator

The administrator of your personal data related to the reporting of adverse reactions is US Pharmacia sp. z o.o. Personal data will be processed for purposes related to the implementation of the legal obligation to monitor the safety of medicinal products. You have the right of access to the content of your data, as well as the right to rectification, restriction of processing, the right to object. You also have the right to file a complaint with the President of the Office for Personal Data Protection if you consider that the processing of your personal data violates the provisions of the RODO. Full information on the processing of personal data is available [here](https://uspharmacia.pl/regulamin-i-polityki/).