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Reporter Type

Please use this reporting form to report any side effects experienced or any concerns about the safety or quality of an e-cigarette or e-liquid. If you wish to report non compliance of a product with the regulations, please email your concerns to TPD.safety@mhra.gov.uk.

Contact Email

Email address

Please note this email address has previously been registered with the Yellow Card site, you can login here. Logging in will save you time and you can then keep a track of submitted reports.

Please provide an email address to receive notifications about your submission.

1. Reporter Details

Fields that you must complete are marked with this symbol: Required

Profession Required

If you are a healthcare professional we ask for your occupation as this helps us to have a better understanding of the case.

Title

First name

Surname

Contact Method

Address

Hospital/ Practice Name / Organisation Required

Professional Address line 1 Required

Professional Address line 2

Town/City

County

Postcode

I do not wish to provide a postal address (N.B. For us to understand the region post code is mandatory)

Telephone Number

Number

Extension

Privacy Policy

The information provided in your report will be handled in line with our privacy policy. Please confirm that you understand this policy. Required

Form actions Step 1. Reporter Details