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Generic Drug Problem Report

If you believe that a generic drug has not acted like the original drug, we would like to know about it. We are collecting and organizing this information and may publish it. We might test the product in the future.

Please complete the form below as accurately as possible. You may need to check the label on the drug.

Your First Name/ Alias
Will appear on your report
Email Address (optional)
Only to contact you for additional information
Generic Drug and Strength
Example: Bupropion XL 300 mg
Company
Brand or Distributor
Manufacturer
If different from brand/distributor above
Pharmacy Where Purchased
Example: CVS, White Plains, NY
When Purchased
Example: October 2007
Original Drug Used and Strength
Example: Wellbutrin XL 300 mg

Description


 



 

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