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Adverse Event and Product Quality Reporting

If you suspect an adverse event either in animals or humans may be associated with the use of an MSD Animal Health product and/or you suspect a product quality issue with an MSD product or device please report the details immediately using the form below.

For further advice about a case please call 01908 685685.

Fields marked with * are mandatory, ** only one field is mandatory

Your details

Your full name: *

Title: *

Dr

Mr

Mrs

Ms

Other

Title: Other

Your role: *

Your role: Other (please specify)

Preferred contact details and time for callback: *

Phone:

Preferred time for call:

Email:

Address:

Are you contacting us about (please select all that apply):

Are you contacting us about (please select all that apply)

An adverse event in an animal(s) relating to the use of an MSD Animal Health product?

An adverse event in a human(s) relating to the use of an MSD Animal Health product?

A suspected fault with an MSD Animal Health product or device?

A concern relating to off-label use or misuse of an MSD Animal Health product?

Animal details

Number of animals affected:

Species:

Species: Other (please specify)

Breed (if applicable):

Animal name (if applicable):

Owner surname:

Animal’s Age:

Sex: *

M

MN

F

FN

Multiple animals

Weight (if known):

Clinical status of animal at time of administration including details of any concurrent conditions: *

Human details

Is this about yourself?

Yes

No

If this is about someone else, do we have permission to collect their details?

Yes

No

Full Name:

Phone number:

Email:

Address:

Do we have permission to contact them? *

Yes

No

Preferred contact details of affected person(s) and time for callback:

Other information:

Practice details

Practice/Company name: *

Address:

Postcode:

Practice telephone number:

Name of attending vet:

Product details

Product name: *

Date(s) administered (where applicable):

Batch numbers (if known):

Formulation (e.g. tablets/liquid/injection): *

Strength (if known/where relevant):

Temperature of product at time of administration (if known):

List any other products used concurrently:

Where applicable, give details of route, site and dose for each product administered:

Please describe your concern as fully as possible: *

Was any treatment required and the noted response suspected adverse event or lack of efficacy: *

Were any laboratory investigations including provision of the corresponding results: *

Current status of case – resolved/ on-going reporters opinion for this report: *

Has this already been reported to the VMD via the "Yellow form" SSARS scheme?

Yes

No

Do you require a discussion regarding this case? *

Yes

No

Reference number (if known)

Have you previously spoken to MSD Animal Health regarding this case? *

Yes

No

Case reference number

Add a new file

Please attach any further relevant documents including reports, correspondence or photos.

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

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Registered office: MSD Animal Health UK Limited, Walton Manor, Walton, Milton Keynes MK7 7AJ, UK. Registered in England & Wales no. 946942.

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