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Dietary Supplement or Nutritional Product Problem Report

If you believe that a dietary supplement (e.g., vitamin, mineral, or herbal supplement) or other nutritional product has caused an unexpected, adverse reaction, 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. You may also want to report the problem to the U.S. FDA through their Safety Reporting Portal at

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

Your First Name/ Alias
Will appear on your report
Email Address (optional)
Only to contact you for additional information
Product Name
(as complete as possible, including strength)
Manufacturer or Distributor
(Typically on back of label)
Product Expiration Date, "Best By" Date, or Lot Number
Place of Purchase
Location or Web Address of Place of Purchase
When Purchased
Description of Problem


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