Adverse Reaction Report Form - SellmerDiers
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An adverse reaction is a serious inadvertent adverse event, including a transmittable disease, that arises in the recipient or in the donor child in connection with the use of donor sperm.

According to the EU Tissues and Cells Directive and the Danish Vævslov suspected adverse reactions must be reported immediately to SellmerDiers.

We thank you for your cooperation.

Adverse Reaction Report Form

  • INFORMATION ABOUT THE PERSON REPORTING THE ADVERSE REACTION

  • INFORMATION ABOUT THE ORDER AND THE DONOR SPERM

  • Obtained from SellmerDiers when the order was placed
  • Unique donation number found on the sperm unit
  • INFORMATION ABOUT THE ADVERSE REACTION

  • Date Format: DD slash MM slash YYYY
  • Tilladte filtyper: word, pdf, jpeg, gif, tif.
Jeg ønsker at hjælpe folk, der ikke kan få børn med at få noget af det mest betydningsfulde i deres liv. Citat Strong
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