Cosmetic Undesirable Effect

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Consumer
Questionnaire

Biorius serves as the Responsible Person for various cosmetic brands. Both Biorius and the brands we represent prioritize the safety of the products placed on the market and remain highly vigilant in this regard. Understanding the potential cause of the adverse effect you experienced is of utmost importance to us.

To help us investigate the situation thoroughly and, if necessary, take steps to improve the product, we kindly request that you complete the following form. The questions are based on the guidelines outlined in Resolution ResAP(2006)1 of the Council of Europe. Once submitted, one of our experts will contact you via email to follow up on your case.

Please note that answering all the questions or providing complete information is not mandatory. However, the more details you provide, the better and faster we will be able to assist you.

The data collected by Biorius will be processed in full compliance with all legal obligations regarding the protection of personal data.

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A. Consumer Information

First Name




Last Name





MM slash DD slash YYYY

Sex




Medical History

Do you have sensitive or reactive skin?


Are you sensitive or allergic to




Have you previously suffered from







B. Suspected Product

C. Conditions of Use for the Product


MM slash DD slash YYYY


MM slash DD slash YYYY


MM slash DD slash YYYY

D. Undesirable Effect Description


MM slash DD slash YYYY


MM slash DD slash YYYY

Symptoms still ongoing


How long after the application did the reaction occur?





How long did this reaction last?



Did you stop using the product?


Did you seek a health-care professional medical attention?


Did you use a medical treatment?


Did you reapply the product after the symptoms disappeared?


Was the re-application done similarly?


Did symptoms appear again?


Have you been hospitalized in connection with this event?


If yes, did it last more than 24 hours?


Did you have a sick leave in connection with this event?


Max. file size: 50 MB.

Max. file size: 50 MB.