info@weiserpharma.com

call us: +(202) 46652387

Reporting to the Blue Card Scheme
Thank you for choosing to report a suspected adverse reaction to the Blue Card Scheme. The information that you provide can help us in our work to identify previously unrecognised side effects, and thereby improve the safe use of medicines. To be able to submit a report, we need you to provide basic information about:

  • The suspected reaction(s)
  •  The drug(s) you suspect caused the reaction(s)
  • Details of the patient
  • Your contact details as the reporter of the reaction

if you are able to provide any extra information (i.e. dates of the suspected reactions, any relevant patient history, other medications being taken at the time of the reaction), then this can be added in the final section of the report – the 'additional details' screen.
Please fill the Blue Card Form

Antiseptic & Disinfectants Incident Reporting Form

This form is to be filled with health care specialist, contact persons or their relatives

* If you suspect that an incident may be related to use of certain Antiseptic or Disinfectant you should complete this form and send it to the address shown at the end of the form .
* Please report all serious and minor adverse reactions .

  • male

    female

  • Antiseptic

    Disinfectant

  • yes

    no

  • Critical use

    Semi critical use

    Non critical use

  • Personal domestic use

    Professional health care use

  • Solution

    Wipes

    Foam

    spray

    gel

    Shampoo

    other

  • Home

    Hospital

    Lab

    other

  • Eye

    Respiratory (Inhalation)

    Skin

    Unknown

  • Floors

    Benches

    Other

  • yes

    no

  • yes

    no

  • Hospitalization

    Life threatening

    Permanent disability

    died

    Congenital abnormalities

    Required intervention to prevent damage

    Other (specify)

  • yes

    no

    Unknown

  • Patient

    Physician

    Pharmacist

    Nurse

    Other

  • Weiser Pharma Factory
  • The information in this report is confidential and totally protected including both the Patient and Reporter identity.
  • You can send voluntarily the incident Reports to the Biocides Vigilance Department (BVD).
  • Reporting for Biocides , incidents are vital for safe & effective usage of antiseptic and disinfectant. Enough information will help the Department to evaluate the Safety & Efficacy of the antiseptic and disinfectants marketed in our Country
    address : 21 Abd Elaziz Al Souad st. – Manial – Cairo PO Box: 11451    tel number : +2 02 23648046 / +2 02 23640368 / +2 02 23684381    Fax : +2 02 23684194   E-mail : Biocides.epvc@eda.mohp.gov.eg   Website : www.epvc.gov.eg   Extension No. (Tel) : 1303    Extension No. (Fax) : 1300

Weiser pharma
El Obour City, North extension- Block 12011, piece 13
Tel: +(202) 46652387
Fax: +(202) 46652387

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