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Report an adverse reaction

Veterinary Adverse Drug Reaction report (FDA Form 1932a), required under the FDA Emergency Use Authorization for New World Screwworm. Complete it online below, or download the form and return it by email.

Prefer to download?

Download FDA Form 1932a, complete it, and email it to info@f10products.com.

Download the form (PDF) ↓

Reporting to the FDA directly

You may also report an adverse event directly to the FDA using Form FDA 1932a at fda.gov/reportanimalae or by phone on 1-888-FDA-VETS (1-888-332-8387).

Complete the report online

Fields follow FDA Form 1932a. Complete as much as you can — only your name and email are required so we can acknowledge the report; the more detail you provide, the more useful the report.

Sender information
Sender Category
Preferred Method of Contact
Previously Reported to the Manufacturer?
Health-care professional information

If different from Sender information.

Owner information

If different from Sender information.

Product use information for suspected product
Product Administered by
Adverse event information
Level of Suspicion that Product Caused the Adverse Event
Did the Event Abate After Stopping the Product?
Did the Event Reappear After Reintroduction?
Outcome
Species and related information
Species
Overall Health Status When Product Given
Adverse event occurrence
When the Event Occurred, Treatment with the Suspected Product:
Concurrent clinical problem(s)
Were there concurrent clinical problems?
Concurrent product information

Excluding treatment of the current event.

Were concurrent products administered?
Adverse event / product problem / use error — narrative
Document information

Reference any supporting documents by name and description. To attach the files themselves, email them to info@f10products.com quoting your name.

or download the PDF instead ↓