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AllergenMeds

For patients, families and health care professionals

Share your story

If an inactive ingredient in a medication caused a reaction, a missed dose, or hours of phone calls for you, someone you care for, or a patient, we would like to hear about it. We use these stories to understand the problem and, with your permission, to show the FDA and lawmakers why medication labels need more detail about inactive ingredients.

  • Takes about five minutes
  • Only the first question is required
  • You choose how it can be used
Not sure where to start?

Example sentence to finish: I found out there was (an ingredient) in (a medication) when (what happened)

You could begin by finishing this sentence.

  1. Tell us what happened

    Use your own words. A few sentences is enough.

  2. Choose how it can be used

    You can keep it with our team or allow us to share it.

  3. We contact you before sharing

    We email you the exact wording first. If you do not reply, we do not use it.

This form is not for medical help or for reporting a reaction to the FDA. If someone is having a reaction right now, call 911.

About you

A few questions about you.

Which best describes you?

This helps us share stories with lawmakers in your state.

Your story

Only the first question is required.

Use your own words. A few sentences is enough.

0 of 5,000 characters

The name on the box or bottle is fine. The strength, maker, or NDC help if you have them.

For example: lactose, gluten or wheat starch, a dye, gelatin, PEG, or something avoided for religious or diet reasons.

How we may use your story

Your story stays with our team unless you check one of the boxes below. We will contact you before we share anything.

What we collect
What you write on this form, your role, and your email if you give it. It may include health details about you, your child, or a patient.
Why
To learn how inactive ingredients in medications affect people and to improve our tools, plus any uses you allow on this form.
Who sees it
Our team and the companies that host our website, database and email for us. It is never sold. It goes further only if you check a sharing box.
Changing your mind
Email hello@allergenmaps.org with your reference number and we will stop using your story and delete it. We cannot pull back copies already sent to the FDA, lawmakers, or reporters.
Sharing beyond our team (optional)

Before your story is used in public, we will email you the exact wording and how you will be named. If you do not reply, we will not use it. We cannot use every story. If we use yours, we may shorten it or fix spelling, but we will not change its meaning.

Questions marked * are required.