Adverse Reaction Report Home Adverse Reaction Report Step 1 of 4 Information about the patient, who experienced the adverse reaction This report applies to* n/amyselfa / my childother person as follows: Initials* Birth date or age* Gender* n/afemalemaledivers Country and Postal code (please enter the first 3 digits) Height Weight * Mandatory field [multistep "1-4-/en/adverse-reaction-report-2"]