Adverse Event

Quality Concern or Adverse Event

Use this form to submit questions about the quality of an Alcon product or to report an adverse event.

Contact Information

Courtesy title (Optional)

Mr. Mrs. Dr. Ms.

First name

Last name

E-mail

Phone number

Physical Address

Street

City

State (optional)

Postal Code (optional)

Country

Alcon product categories

Contact lenses and contact lens care products
Prescription and over-the-counter products
Implanted devices (intraocular lenses or glaucoma filtration device)
Surgical products
Other Alcon products

Product name

Please be specific.
Give the name as it appears on the product label if possible.

Product lot Serial number (need help finding this?)

Product expiration date (if available)

Your Question or Request

Please include the following information (if available):

was this your first time using the product
the date of the event
what was your experience
which eye(s) was/were involved
whether medical intervention was required
whether the issue has been resolved

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