Adverse Event Report

The FDA considers hand sanitizer an over-the-counter drug. As such, we are required to collect and report any adverse effects encountered by our customers to the FDA by providing them with the information we collect in the form below. The FDA considers an Adverse Event to be any undesirable event that is associated with the use of a drug or biological product in humans whether or not considered product-related by the applicant. For example: rash, burn, skin peeling, skin cracking, redness, etc.

  • Patient Information

  • Note: Do NOT use any personally identifiable information. Use their initials instead of the name. DO NOT use any sensitive data such as SSN.
  • The Product Used

  • The Specific Adverse Event

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY