Reporting a quality defect in a medicine - human or animal use

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Reporter information
Product information
Defect information
Photos & files
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Reporter information

Title

First name

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Surname

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Organisation

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Department

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Address line 1

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Address line 2

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Address line 3

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City

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County

Country

Eircode

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Telephone

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Mobile

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Email

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Confirm email

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Reporter type

Other

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