As a pharmaceutical company, we collect product complaints and other safety information on all our products, including pens, needles and vials. We do this for surveillance of product quality and for potential reporting to health authorities.
* - mandatory
Please select your location in the drop down {{crossValidationError['country'].crossValidationErrorMessage}}

First name *

Please enter your first name

Last name *

Please enter your last name
Check if you are a healthcare professional (HCP) *
This is a required field {{crossValidationError['hcp'].crossValidationErrorMessage}}
This is a required field

Phone number *

Please enter your phone

Your e-mail *

Please enter e-mail address Please enter e-mail address

Address 1 *

Bu alanın doldurulması gereklidir {{crossValidationError['address1'].crossValidationErrorMessage}}

Address 2 *

Bu alanın doldurulması gereklidir {{crossValidationError['address2'].crossValidationErrorMessage}}

Town *

Please enter your phone {{crossValidationError['town'].crossValidationErrorMessage}}

County *

Please enter your last name {{crossValidationError['county'].crossValidationErrorMessage}}

Postcode *

This is a required field

Name of the product *

Please enter the name of the product

The product batch/LOT number *

Please enter your last name {{crossValidationError['theProductBatchLOTNumber'].crossValidationErrorMessage}}
Is the faulty product available for return to Novo Nordisk? *
{{crossValidationError['isTheFaultyProductAvailableForReturnToNovoNordisk'].crossValidationErrorMessage}}

Please describe the product issue(s) *

Please describe the product issue(s)

*

You can only attach up to 10MB Following file extensions are allowed: .xls,.xlsx,.doc,.docx,.ppt,.pptx,.pdf,.msg,.eml,.jpg,.jpeg,.png {{crossValidationError['attachment'].crossValidationErrorMessage}}
Privacy disclaimer * *
You must accept Privacy Disclaimer
hCAPTCHA verification required