Idorsia Product Quality Complaint Form

We strongly encourage you to report any PRODUCT QUALITY ISSUE OR PROBLEM related to one of our products. Please report your PRODUCT QUALITY COMPLAINT using the following form.

If this is an emergency, please contact your local healthcare provider immediately

Complaint Information

Please enable JavaScript in your browser to complete this form.
The country from which the TPC was reported
Date in which the defect occurred.
A detailed description of the defect and related information.

Product Information

Select the reported product
Dosage type i.e. tablet, capsule, vial, pre-filled syringe
This information can be found on the product container.
This information can be found on the product container.
This information can be found on the product container.
Can the reporter provide the sample, for further investigation, if requested?
Can the reporter provide a picture of the product for investigation?
Has the product been administered before the quality issue was discovered

Reporter Information

Captures whether the reporter has consented to be contacted
Select from the pick-list the most appropriate description
Firstame of the Complainant (person who reported the complaint to Idorsia)
Lastname of the Complainant (person who reported the complaint to Idorsia)
At least TWO (2) forms of contact details for the Initial Reporter, such as email address, phone number, fax number and postal address
At least TWO (2) forms of contact details for the Initial Reporter, such as email address, phone number, fax number and postal address
At least TWO (2) forms of contact details for the Initial Reporter, such as email address, phone number, fax number and postal address
At least TWO (2) forms of contact details for the Initial Reporter, such as email address, phone number, fax number and postal address

Idorsia retains your personal data to address or provide a reply to your medical information inquiry. In processing your personal data, Idorsia will fully comply with internationally recognized standards of data protection. In doing so, Idorsia ensures compliance of its staff with strict standards of security and confidentiality. Additional information on the processing of personal data and the exercise of rights related to your personal data can be found in Idorsia’s Privacy Policy