Patient reporting of adverse drug or health product events via a patient form (Form 15031*04)

Ministry of Health - Cerfa n° 15031*04

Helps to report any side effects you may have noticed after taking a medicine.

Go to the online administrative form

Verified 01 April 2021 - Directorate for Legal and Administrative Information (Prime Minister)

To whom shall I send this form ?

For details, please use the practical information sheets :

J'ai réalisé une démarche administrative

Je donne mon avis sur Services Publics +. L'administration concernée me répondra.