InfoCons Consumer Protection informs you – Cervarix – Package Leaflet

Cervarix – Package Leaflet: InfoCons – Consumer Protection presents, in an accessible format, the official package leaflet of the medicine Cervarix, as authorised in the European Union and published in the Union Register of medicinal products.

📋 Cervarix – at a glance

Active substance	Human Papilloma Virus-16 and Human Papilloma Virus 18 L1 proteins
ATC code	J07BM02
EU authorisation number	EU/1/07/419
Marketing Authorisation Holder	GlaxoSmithKline Biologicals S.A.
Therapeutic indication	Cervarix is a vaccine for use from the age of 9 years for the prevention of premalignant ano-genital lesions (cervical, vulvar, vaginal and anal) and cervical and anal cancers causally related to certain oncogenic Human Papillomavirus (HPV) types. See sections 4.4 and 5.1 for important…
Last Commission decision	2024-03-14

Before anything else

Read all of this leaflet carefully before you start receiving this vaccine because it contains important information for you .

Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you only . Do not pass it on to others.
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

What is i n this leaflet:

1. What Cervarix is and what it is used for 2. What you need to know before you receive Cervarix 3. How Cervari x is given 4. Possible side effects 5. How to store Cervarix 6. Contents of the pack and other information 1. What Cervarix is and what it is used for Cervarix is a vaccine intended to protect from the age of 9 years against the diseases caused by infection with Human Papillomaviruses (HPV).

These diseases include:

cervical cancer (cancer of the cervix i.e. lower part of the uterus or womb) and anal cancer ,
precancerous cervical , vulvar, vaginal and anal lesions (changes in genital or anal cells that have a risk of turning into cancer).

The Human Papillomavirus (HPV) types contained in the vaccine (HPV types 16 and 18) are responsible for approximately 70% o f cervical cancer s, 90% of anal cancers, 70% of HPV -related pre- cancerous lesions of the vulva and vagina and 78% of HPV- related pre- cancerous lesions of the anus .

Other HPV types can also cause ano-genital cancer s. Cervarix does not protect against all HP V types.

When a female or a male individual is vaccinated with Cervarix, the immune system (the body’s natural defence system) will make antibodies against HPV types 16 and 18.

Cervarix is not infectious and so, it cannot cause HPV related diseases.

Cervarix is not used to treat HPV related diseases already present at the time of vaccination.

Cervarix should be used in accordance with official guidelines.

2. What you need to know before you receive Cervarix Cervarix should not be given :

if you are allergic to any of the active substances or any of the other ingredients of this vaccine (listed in section 6) . Signs of an allergic reaction may include itchy skin rash, shortness of breath and swelling of the face or tongue.

38 Warnings and precautions Talk to your doctor or pharmacist before you are given Cerv arix

if you have a bleeding problem or bruise easily.
if you have any disease which reduces your resistance to infection such as HIV infection .
if you have a severe infection with a high temperature. It might be necessary to postpone the vaccination until recovery. A minor infection such as a cold should not be a problem, but talk to the doctor first.

Fainting can occur (mostly in adolescents) following, or even before, any needle injection. Therefore tell the doctor or nurse if you or your child fainted w ith a previous injection.

As with all vaccines, Cervarix may not fully protect all people who are vaccinated.

Cervarix does not protect people from diseases caused by infection with HPV types 16 or 18 if they are already infected with Human Papillomaviru s type 16 or 18 at the time of vaccination.

Although vaccination may protect you against cervical cancer, it is not a substitute for regular cervical screening. You should continue to follow your doctor’s advice on cervical smear/Pap test (test to screen for changes in cells of the cervix caused by an HPV infection) and preventative and protective measures.

As Cervarix will not protect against all types of Human Papillomavirus, appropriate precautions against exposure to HPV and sexually transmitted disea ses should continue to be used.

Cervarix will not protect against other diseases that are not caused by Human Papillomavirus.

Other medicines and Cervarix

Cervarix can be given with a combined booster vaccine containing diphtheria (d), tetanus (T) and pertussis [acellular] (pa) with or without inactivated poliomyelitis (IPV), (dTpa, dTpa – IPV vaccines), with a combined hepatitis A and hepatitis B vaccine (Twinrix) or a hepatitis B vaccine (Engerix B), or with a meningococcal serogroups A, C, W -135, Y teta nus toxoid conjugate vaccine (MenACWY -TT), at a separate injection site (another part of your body, e.g. the other arm) during the same visit .

Cervarix may not have an optimal effect if used with medicines that suppress the immune system.

In clinical trials, oral contraceptives (e.g. the pill) did not reduce the protection obtained by Cervarix.

Tell your doctor if you are taking, have recently taken , might take any other medicines, or have recently received any other vaccine.

Pregnancy , breast -feeding and fertility If you are pregnant, i f pregnancy occurs during the course of vaccination or if you are trying to become pregnant i t is recommended to postpone or interrupt vaccination until after completion of the pregnancy.

If you are pregnant or breast -feeding, think that you may be pregnant or are planning to have a baby, ask your doctor for advice before you are given this vaccine .

Driving and using machines

Cervarix is not likely to affect your ability to drive or use machines. However , do not drive or use any machines if you are feeling unwell.

Cervarix contains sodium chloride.

This vaccine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially “sodium – free”.

3. How Cervarix is given How the vaccine is given The doctor or nurse will give Cervarix as an injection into the muscle of the upper arm.

How much is given Cervarix is intended for use from 9 years of age onwards.

The total number of injections you will receive depends on your age at the time of the first injection.

If you are between 9 and 14 years old You will receive 2 injections:

First injection: at chosen date Second injection: given between 5 and 13 months after first injection If you are 15 years old or above You will receive 3 injections:

First injection: at chosen date Second injection: 1 month after first injection Third injection: 6 months after first injection If necessary, the vaccination schedule can be more flexible. Please speak to your doctor for more information.

When Cervarix is given for the first dose, it is recommended that Cervarix (and not another vaccine against HPV) be given for the comp lete vaccination course.

Cervarix is not recommended for use below 9 years of age .

The vaccine should never be given into a vein.

If you miss a dose It is important that you follow the instructions of your doctor or nurse regarding return visits. If you forget to go back to your doctor at the scheduled time, ask your doctor for advice.

If you do not finish the complete vaccination course (two or three injections depending on your age at vaccination) , you may not get the best response and protection f rom the vaccination.

4. Possible side effects Like all medicines, this vaccine can cause side effects, although not everybody gets them.

Side effects that occurred during cli nical trials with Cervarix were as follows: ♦ Very common (side effects which may occur in more than 1 per 10 doses of vaccine):

pain or discomfort at the injection site
redness or swelling at the injection site
headache
aching muscles, muscle tenderness or weakness (not caused by exercise)
tiredness 40 ♦ Common (side effects which may occur in less than 1 per 10 but more than 1 per 100 doses of vaccine):
gastrointestinal symptoms including nausea, vomiting, diarrhoea and abdominal pain
itching, red skin rash, hives (urticaria)
joint pain
fever (≥38°C) ♦ Uncommon (side effects which may occur in less than 1 per 100 but more than 1 per 1,000 doses of vaccine):
upper respiratory tract infection (infection of the nose, throat or trachea)
dizziness
other injection site reactions such as hard lump, tingling or numbness .

Side effects that have been reported during marketed use of Cervarix include:

allergic reactions. These can be recognised by: itchy rash of the hands and feet , swelling of the eyes and face , difficulty in breathing or swallowing, sudden drop in blood pressure and loss of consciousness .

These reactions will usually occur before leaving the doctor’s surgery. However, if your child gets any of these symptoms you should contact a doctor urg ently.

swollen glands in the neck, armpit or groin
fainting sometimes accompanied by shaking or stiffness .

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist . This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V . By reporting side effects you can help provide more information on the safety of this med icine.

5. How to stor e Cervarix Keep this vaccine out of the sight and reach of children.

Do not use this vaccine after the expiry date which is stated on the carton. The expiry date refers to the last day of that month.

Store in a refrigerator (2 °C – 8°C).

Do not freeze.

Store in the original package in order to protect from light.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use . These measures will help to protect the environment.

6. Contents of the pack and other information

What Cervarix contains

The active substances are:

Human Papillomavirus 1 type 16 L1 protein2,3,4 20 micrograms Human Papillomavirus1 type 18 L1 protein2,3,4 20 micrograms 41 1Human Papillomavirus = HPV 2adjuvanted by AS04 containing:

3-O-desacyl -4’- monophosphoryl lipid A (MPL)3 50 micrograms 3adsorbed on aluminium hydroxide, hydrated (Al(OH) 3) 0.5 milligrams Al3+ in total 4L1 protein in the form of non- infectious virus -like particles (VLPs) produced by recombinant DNA technology using a Baculovirus expression system which uses Hi -5 Rix4446 cells derived from the insect Trichoplusia ni .

The other ingredients are sodium chloride (NaCl), sodium dihydrogen phosphate dihydrate (NaH 2PO 4.2 H 2O) and water for injections.

What Cervarix looks like and contents of the pack

Suspension for injection.

Cervarix is a turbid white suspension.

Cervarix is available in 1 dose vials (0.5 ml) in packs of 1, 10 and 100.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

GlaxoSmithKline Biologicals s.a.

Rue de l’Institut 89 B-1330 Rixensart, Belgium For any information about this medicine , please contact the local representative of the Marketing Authorisation Holder:

Belgique/België/Belgien GlaxoSmithKline Pharmaceuticals SA./NV Tél/Tel: + 32 10 85 52 00 Lietuva GlaxoSmithKline Biologicals SA Tel: +370 80000334 България GlaxoSmithKline Biologicals SA Тел. +359 80018205 Luxembourg/Luxemburg GlaxoSmithKline Pharmaceuticals SA./NV Tél/Tel: + 32 10 85 52 00 Česká republika GlaxoSmithKline s.r.o.

Tel: + 420 2 22 00 11 11 cz.info @gsk.com Magyarország GlaxoSmithKline Biologicals SA Tel.: +36 80088309 Danmark GlaxoSmithKline Pharma A/S Tlf: + 45 36 35 91 00 [email protected] Malta GlaxoSmithKline Biologicals SA Tel: +356 80065004 Deutschland GlaxoSmithKline GmbH & Co. KG Tel: + 49 (0)89 360448701 [email protected] Nederland GlaxoSmithKline BV Tel: + 31 (0)33 2081100 42 Eesti GlaxoSmithKline Biologicals SA Tel: +372 8002640 Norge GlaxoSmithKline AS Tlf: + 47 22 70 20 00 Ελλάδα GlaxoSmithKline Μονοπρόσωπη A.E.B.E Tηλ: + 30 210 68 82 100 Österreich GlaxoSmithKline Pharma GmbH Tel: + 43 (0)1 97075 0 [email protected] España GlaxoSmithKline , S.A.

Tel: + 34 900 202 700 [email protected] Polska GSK Services Sp. z o.o.

Tel.: + 48 (22) 576 9000 France Laboratoire GlaxoSmithKline Tél: + 33 (0) 1 39 17 84 44 [email protected] Hrvatska GlaxoSmithKline Biologicals SA Tel.: +385 800787089 Portugal GlaxoSmithKline – Produtos Farmacêuticos, Lda.

Tel: + 351 21 412 95 00 [email protected] România GlaxoSmithKline Biologicals SA Tel: +40 800672524 Ireland GlaxoSmithKline (Ireland) Ltd Tel: + 353 (0)1 495 5000 Slovenija GlaxoSmithKline Biologicals SA Tel: +386 80688869 Ísland Vistor hf.

Sími: +354 535 7000 Slovenská republika GlaxoSmithKline Biologicals SA Tel.: +421 800500589 Italia GlaxoSmithKline S.p.A.

Tel:+ 39 (0)45 7741 111 Suomi/Finland GlaxoSmithKline Oy Puh/Tel: + 358 10 30 30 30 Κύπρος GlaxoSmithKline Biologicals SA Τηλ: +357 80070017 Sverige GlaxoSmithKline AB Tel: + 46 (0)8 638 93 00 [email protected] Latvija GlaxoSmithKline Biologicals SA Tel: +371 80205045 United Kingdom (Northern Ireland) GlaxoSmithKline Biologicals SA Tel: +44(0)800 221441 [email protected]

This leaflet was last revised in

Other sources of information Detailed information on this medicine is available on the European Medicines Agency web site: http://www.ema.europa.eu. ————————————————————————————————————————- 43 The followin g information is intended for healthcare professionals only:

Cervarix should be administered as soon as possible after being removed from the refrigerator. However , stability has been demonstrated when stored outside the refrigerator for up to 3 days at temperatures between 8°C and 25°C or for up to 1 day at temperatures between 25°C and 37°C. If not used at the end of this period the vaccine should be discarded.

A fine white deposit with a clear colo urless supernatant may be observed upon storage of the vial. This does not constitute a sign of deterioration.

The content of the vial should be inspected visually both before and after shaking for any foreign particulate matter and/or abnormal physical a ppearance prior to administration.

In the event of either being observed, discard the vaccine.

The vaccine should be well shaken before use.

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.

44 Package leaflet: Information for the user Cervarix suspension for injection, multidose container Human Papillomavirus vaccine [Types 16, 18] (Recombinant, adjuvanted, adsorbed) Read all of this leaflet carefully before you start receiving this vaccine because it contains important information for you .

Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you only. Do not pass it on to others.
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

ℹ️ 1. What Cervarix is and what it is used for

Cervarix is a vaccine intended to protect from the age of 9 years against the diseases caused by infection with Human Papillomaviruses (HPV).

These diseases include:

cervical cancer (cancer of the cervix i.e. lower part of the uterus or womb) and anal cancer ,
precancerous cervical , vulvar, vaginal and anal lesions (changes in genital or anal cells that have a risk of turning into cancer).

The Human Papillomavirus (HPV) types contained in the vaccine (HPV types 16 and 18) are responsible for approximately 70% of cervical cancer s, 90% of anal cancers, 70% of HPV -related pre- cancerous lesions of the vulva and vagina and 78% of HPV- related pre- cancerous lesions of the anus .

Other HPV types can also cause ano-genital cancer s. Cervarix does not protect against all HPV types.

When a female or a male individual is vaccinated with Cervarix, the immune system (the body’s natural defence system) will make antibodies against HPV types 16 and 18.

Cervarix is not infe ctious and so, it cannot cause HPV related diseases.

Cervarix is not used to treat HPV related diseases already present at the time of vaccination.

Cervarix should be used in accordance with official guidelines.

⚠️ 2. What you need to know before you rece ive Cervarix

Cervarix should not be given :

if you are allergic to any of the active substances or any of the other ingredients of this vaccine (listed in section 6) . Signs of an allergic reaction may include itchy skin rash, shortness of breath and swelling of the face or tongue.

52 Warnings and precautions Talk to your doctor or pharmacist before you are given Cervarix

if you have a bleeding problem or bruise easily.
if you have any disease which reduces your resistance to infection such as HIV infection .
if you have a severe infection with a high temperature. It might be necessary to postpone the vaccination until recovery. A minor infection such as a cold should not be a problem, but talk to the doctor first.

Fainting can occur (mostly in adolescents) following, or even before, any needle injecti on. Therefore tell the doctor or nurse if you or your child fainted with a previous injection.

As with all vaccines, Cervarix may not fully protect all people who are vaccinated.

Cervarix does not protect people from diseases caused by infection with HPV types 16 or 18 if they are already infected with Human Papillomavirus type 16 or 18 at the time of vaccination.

As Cervarix will not protect against all types of Human Papillomavirus, appropriate precautions against exposure to HPV and sexually transmitted diseases should continue to be used.

Cervarix will not protect against other diseases that are not caused by Human Papillomavirus.

Other medicines and Cervarix

Cervarix can be given with a combined booster vaccine containing diphtheria (d), tetanus (T) and pertussis [acellular] (pa) with or without inactivated poliomyelitis (IPV), (dTpa, dTpa – IPV vaccines), with a combined hepatitis A and hepatitis B vaccine (Twinrix) or a hepatitis B vac cine (Engerix B), or with a meningococcal serogroups A, C, W -135, Y tetanus toxoid conjugate vaccine (MenACWY -TT), at a separate injection site (another part of your body, e.g. the other arm) during the same visit .

Cervarix may not have an optimal effect if used with medicines that suppress the immune system.

In clinical trials, oral contraceptives (e.g. the pill) did not reduce the protection obtained by Cervarix.

Tell your doctor if you are taking, have recently taken , might take any other medicines , or have recently received any other vaccine.

Pregnancy , breast -feeding and fertility If you are pregnant, i f pregnancy occurs during the course of vaccination or if you are trying to become pregnant it is recommended to postpone or interrupt vaccination until after completion of the pregnancy.

If you are pregnant or breast -feeding, think that you may be pregnant or are planning to have a baby, ask your doctor for advice before you are given this vaccine .

Driving and using machines

Cervarix is not likely to affect your ability to drive or use machines. However, do not drive or use any machines if you are feeling unwell.

Cervarix contains sodium chloride.

This vaccine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially “sodium – free”.

💊 3. How Cervarix is given

How the vaccine is given The doctor or nurse will give C ervarix as an injection into the muscle of the upper arm.

How much is given Cervarix is intended for use from 9 years of age onwards.

The total number of injections you will receive depends on your age at the time of the first injection.

If you are between 9 and 14 years old You will receive 2 injections:

First injection: at chosen date Second injection: given between 5 and 13 months after first injection If you are 15 years old or above You will receive 3 injections:

When Cervarix is given for the first dose, it is recommended that Cervarix (and not another vaccine against HPV) be given for the complete vaccination course.

The vaccine should never be given into a vein.

Cervarix is not recommended for use below 9 years of age.

If you do not finish the complete vaccination course (two or three injec tions depending on your age at vaccination) , you may not get the best response and protection from the vaccination.

❗ 4. Possible side effects

Like all medicines, this vaccine can cause side effects, although not everybody gets them.

Side effects that occurred during clinical trials with Cervarix were as follows: ♦ Very common (side effects which may occur in more than 1 per 10 doses of vaccine): pain or discomfort at the injecti on site , redness or swelling at the injection site , headache, aching muscles, muscle tenderness or weakness (not caused by exercise) , tiredness . ♦ Common (side effects which may occur in less than 1 per 10 but more than 1 per 100 doses of vaccine): gastrointestinal symptoms including nausea, vomiting, diarrhoea and abdominal pain, itching, red skin rash, hives (urticaria) , joint pain , fever (≥38°C) . ♦ Uncommon (side effects which may occur in less than 1 per 100 but more than 1 per 1,000 doses of vaccine): upper respiratory tract infection (infection of the nose, throat or trachea) , dizziness , other injection site reactions such as hard lump, tingling or numbness.

Side effects that have been reported during marketed use of Cervarix include:

allergic reactions. These can be recognised by: itchy rash of the hands and feet , swelling of the eyes and face, difficulty in breathing or swallowing, sudden drop in blood pressure and loss of consciousness .

These reactions will usually occur before leaving the doctor’s surgery. However, if your child gets any of these symptoms you should contact a doctor urgently.

swollen glands in the neck, armpit or groin
fainting sometimes accompanied by shaking or stiffness .

Reporting of side effects

🌡️ 5. How to store Cervarix

Keep this vaccine out of the sight and reach of children.

Do not use this vaccine after the expiry date which is stated on the carton. The expiry date refers to the last day of that month.

Store in a refrigerator (2 °C – 8°C).

Do not freeze.

Store in the original package in order to protect from light.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use . These measures will help to protect the environment.

📦 6. Contents of the pack and other information

What Cervarix contains

The active substances are:

Human Papillomavirus 1 type 16 L1 protein2,3,4 20 micrograms Human Papillomavirus1 type 18 L1 protein2,3,4 20 micrograms 1Human Papillomavirus = HPV 2adjuvanted by AS04 containing:

3-O-desacyl -4’- monophosphoryl lipid A (MPL)3 50 micrograms 3adsorbed on aluminium hydroxide, hydrated (Al(OH) 3) 0.5 milligrams Al3+ in total 55 4L1 protein in the form of non- infectious virus -like particles (VLPs) produced by recombinant DNA technology using a Baculovirus expression system which uses Hi -5 Rix4446 cells derived from the insect Trichoplusia ni .

The other ingredients are sodium chlor ide (NaCl), sodium dihydrogen phosphate dihydrate (NaH 2PO 4.2 H 2O) and water for injections.

What Cervarix looks like and contents of the pack

Suspension for injection in pre -filled syringe.

Cervarix is a turbid white suspension.

Cervarix is available in 1-dose pre -filled syringe , with or without separate needles, pack sizes of 1 and 10.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

GlaxoSmithKline Biologicals s.a.

Rue de l’Institut 89 B-1330 Rixensart, Belgium For any information about this medicin e, please contact the local representative of the Marketing Authorisation Holder:

Tel: + 420 2 22 00 11 11 [email protected] Magyarország GlaxoSmithKline Biologicals SA Tel.: +36 80088309 Danmark GlaxoSmithKline Pharma A/S Tlf: + 45 36 35 91 00 [email protected] Malta GlaxoSmithKline Biologicals SA Tel: +356 80065004 Deutschland GlaxoSmithKline GmbH & Co. KG Tel: + 49 (0)89 360448701 [email protected] Nederland GlaxoSmithKline BV Tel: +31 (0)33 2081100 Eesti GlaxoSmithKline Biologicals SA Tel: +372 8002640 Norge GlaxoSmithKline AS Tlf: + 47 22 70 20 00 Ελλάδα GlaxoSmithKline Μονοπρόσωπη A.E.B.E Österreich GlaxoSmithKline Pharma GmbH 56 Tηλ: + 30 210 68 82 100 Tel: + 43 (0)1 97075 0 [email protected] España GlaxoSmithKline , S.A.

Tel: + 34 900 202 700 [email protected] Polska GSK Services Sp. z o.o.

Sími: +354 535 7000 Slovenská republika GlaxoSmithKline Biologicals SA Tel.: +421 800500589 Italia GlaxoSmithKline S.p.A.

This leaflet was last revised in

Other sources of information Detailed information on this medicine is available on the European Medicines Agency web site: http://www.ema.europa.eu. ————————————————————————————————————————- The followin g information is intended for healthcare professionals only:

Cervarix should be administered as soon as possible after being removed from the refrigerator.

However , stability has been demonstrated when stored outside the refrigerator for up to 3 days at temperatures between 8°C and 25°C or for up to 1 day at temperatures between 25°C and 37°C. If not used at the end of this period the vaccine should be discarded.

A fine white deposit with a clear colourless supernatant may be observed upon storage of the syringe.

This does not constitute a sign of deterioration.

The content of the syringe should be inspected visually both before and after shaking for any foreign particulate matter and/or abnormal physical appearance prior to administration.

In the event of either being observed, discard the vaccine.

The vaccine should be well shaken before use.

Instructions for the pre -filled syringe Hold the syringe by the barrel, not by the plunger.

Unscrew the syringe cap by twisting it anticlockwise.

To attach the needle, connect the hub to the Luer Lock Adaptor and rotate a quarter turn clockwise until you feel it lock.

Do not pull the syringe plunger out of the barrel.

If it happens, do not administer the vaccine.

Disposal Any unused medicinal product or waste m aterial should be disposed of in accordance with local requirements.

Plunger Barrel Cap Needle hub

📄 Package Leaflet – official source

This article reproduces the information in the official package leaflet, as authorised in the European Union. You can consult the original document here: Product information Cervarix (PDF, ec.europa.eu).

You can check this medicine at any time in the Union Register of medicinal products (EU number EU/1/07/419).

⚠️ Important: This article is for information purposes only and does not replace medical advice or the package leaflet inside the medicine box. Read the leaflet carefully before use. For any questions about your treatment, talk to your doctor or pharmacist. If you experience side effects, tell your doctor or pharmacist and report them through your national reporting system.