Consumer Form for filing Adverse Event
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Consumer Details
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Event Information
3
Product Information
4
Review and Confirm
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Notification Email (Owner)
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Fetched Email Addresses
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Company Name
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User ID
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CD Record Number
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Dropdown
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Product name text
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Multi Product name text
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Customers Age
Consumer Information
Please enter the contact information for the person who experienced the adverse event.
Consumer Name
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Consumer Email
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Consumer Phone
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Consumer Address 1
Consumer Address 2
Consumer City
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Consumer State
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Consumer Postal Code
Consumer Date of Birth
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Age
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Consumer Date of Birth
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Please enter the date in MM/DD/YYYY format.
MM slash DD slash YYYY
Sex
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Male
Female
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Gender
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Cisgender man/boy (gender corresponds with birth sex)
Cisgender woman/girl (gender corresponds with birth sex)
Transgender man/trans man/ female-to-man (FTM)
Transgender woman/trans woman/male-to-female (MTF)
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Other gender category
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Weight
Weight Unit
Lbs
Kg
Race
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American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Ethnicity
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Hispanic or Latino
Not Hispanic or Latino
Skin Type
Please Select
Dry
Oily
Combination
Skin Reactivity
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Sensitive
Reactive
Non-Sensitive
Person reporting this information is different than the consumer above
Person reporting this information is different than the consumer above.
Reporter Information
Please enter the contact information of the person reporting this adverse event.
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Use consumer address information.
Are you a health professional?
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No
Also sent the report to FDA?
Yes
No
Unknown
Reporter Name
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Reporter Email
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Reporter Phone
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Reporter Occupation
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Administrator/Supervisor
Biomedical Engineer
Dentist
Non-Health Professional
Nurse
Nurse Practitioner
Other Health Professional
Pharmacist
Physician
Physician Assistant
Risk Manager
Third Party Servicer
Reporter Address 1
Reporter Address 2
Reporter City
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Reporter State
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Reporter Postal Code
Adverse Event Information
What happened when you used the product?
(Check all that apply)
Had a bad side effect (including new or worsening symptoms)
Used a product incorrectly which could have led to a problem
Noticed a problem with the quality of the product
Did any of the following occur?
*
(Check all that apply)
Death
Life-threatening experience
Hospitalization (initial or prolonged)
Required intervention to Prevent Permanent Impairment/Damage
Significant disfigurement
Serious and persistent rashes
Second or third degree burns
Significant hair loss
Persistent or significant alteration of appearance
Congenital anomaly/Birth Defects
Infection
Other/None
Date of Demise?
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Please enter the date in MM/DD/YYYY format.
Other
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When did this event occur?
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Please enter the date in MM/DD/YYYY format.
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When did this event occur?
*
MM slash DD slash YYYY
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Product Information
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Product Name
Reaction Details
Symptoms
Reported Symptom
Intensity
Time of onset after applying
Duration of the issue
Was there spontaneous resolution after discontinuation?
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Describe the event and how it happened
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Include as many details as possible
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Are you allergic to any medications, food or other products
Are you allergic to any medications, food or other products?
Other diagnosed illnesses/medical history/chronic health conditions/medical advice regarding adverse effect.
Relevant Test/Laboratory Data/Medical advice regarding adverse effect
Please upload any supporting images/files here
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Product Information
Brand Name
*
Product Name
*
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Brand Name
*
Product Name
*
Please Select
Ceramide Protection 90 capsules
Instant Lift Serum 30 mL
Instant Lift Serum 50 mL (Spa Use)
Melafadin Cleansing Powder 60 g
Melafadin Cleansing Powder 100 g (Spa Use)
Melafadin Toner 100 mL
Melafadin Toner 500 mL (Spa Use)
Brightening Exfoliator 50 mL
Brightening Exfoliator 100 mL (Spa Use)
Brightening Night Care 150 mL (Spa Use)
Fair Complexion Serum 30 mL
Brightening Mask 150 mL
Dark Circle Eye Cream 15 mL
Dark Circle Eye Cream 30 mL (Spa Use)
Skin Resurfacing Balm 75 mL
Brightening Day Protection 50 mL
Brightening Day Protection 100 mL (Spa Use)
Brightening Night Care 50 mL
Magic Glow Serum 50 mL
Probiotics Pro-Immune Serum 30 mL
Probiotics Pro-Immune Serum 50 mL (Spa Use)
Irresistible Eye Elixir 15 mL
Face Guard Advanced 30 mL
Face Guard Advanced 50 mL (Spa Use)
Detox Cream 50 mL
Moor Cream Mask 200 mL (Spa Use)
Fruit Peel Cream Mask 200 mL (Spa Use)
Hydrating Cream Mask 200 mL (Spa Use)
Pomegranate Cream Mask 200 mL (Spa Use)
Snow Algae Hydrating 10 x 15g (Spa Use)
Aloe De-Stress 10 x 30g (Spa Use)
Olive Balancing 10 x 30g (Spa Use)
Goji Anti-Oxidant 10 x 30g (Spa Use)
Spirulina Green Mask 10 x 30g (Spa Use)
Detox Cream 200 mL (Spa Use)
Epigenetic Serum 10 mL
Epigenetic Serum 15 mL (Spa Use)
Retinol Lift Serum 30 mL
Retinol Lift Serum 50 mL (Spa Use)
Hyaluron Lift Eye Pads 3 x 2 pcs
Hyaluron Lift Eye Pads 10 x 2 pcs
Acerola Vitamin C Powder Mask 10 x 30g (Spa Use)
Botanica White Mask 10 x 30g (Spa Use)
Dead Sea Black Mask 10 x 30g (Spa Use)
Exfoliation System Cleanser 250 mL
Perfect Radiance Make Up Shade 00
Perfect Radiance Make Up Shade 01
Perfect Radiance Make Up Shade 02
Eye Make Up Remover 100 mL
Eye Make Up Remover 200 mL (Spa Use)
Perfect Cover Cream Shade 01
Perfect Cover Cream Shade 02
Perfect Cover Cream Shade 03
Perfect Cover Cream Shade 04
Perfect Cover Cream Shade 05
Perfect Powder Fixing 30 mL
Refreshing Shower Mousse 200 mL
Hand Care Cream 50 mL
Vitalizing Leg Lotion 75 mL
Vitaforce ACE Body Cream 150 mL
Perfect Bust Formula 75 mL
Perfect Bust Formula 150 mL
Body Contour Booster 150 mL
Body Contour Booster 250 mL (Spa Use)
Silhouette Contouring Cream 150 mL
Silhouette Contouring Cream 250 mL (Spa Use)
24h Body Moisturizer 150 mL
24h Body Moisturizer 250 mL (Spa Use)
Oriental Body Scrub 1000 mL (Spa Use)
3 Salt Body Scrub 1000 mL (Spa Use)
Stimulating Massage Balm 1000 mL (Spa Use)
Grape Seed Massage Oil 500 mL (Spa Use)
Essential Oil Complex 30 mL (Spa Use)
Thermo Body Pack 2000 g (Spa Use)
Creamy Body Pack 1000 g (Spa Use)
3 Tea Body Pack 1000 g (Spa Use)
Cryogenic Alginate (Arctic) 1000 g (Spa Use)
Body Toning Modelage 500 mL (Spa Use)
Body Toning Elixir 500 mL (Spa Use)
After Sun Lotion 150 mL
Active Shower Gel 200 mL
Calming Hydro Gel 50 mL
24-7 Skin Energizer 50 mL
Energizing Eye Roll 15 mL
Long Lasting Deodorant 30 g
Day Cream 50 mL
Day Cream 100 mL (Spa Use)
Purifying Wash plus Shave 75 mL
Night Cream 50 mL
Night Cream 100 mL (Spa Use)
Effect Serum 30 mL
Effect Serum 50 mL (Spa Use)
Eye Cream 15 mL
Eye Cream 30 mL (Spa Use)
Brilliance Shine Elixir 7 x 2 mL
Brilliance Shine Elixir 25 x 2 mL (Spa Use)
Eye Flash Fluid 7 x 15 mL
Eye Flash Fluid 25 x 15 mL (Spa Use)
Instant Soothing Oil 7 x 2 mL
Instant Soothing Oil 25 x 2 mL (Spa Use)
Skin Contour Fluid 7 x 2 mL
Skin Contour Fluid 25 x 2 mL (Spa Use)
Detox Fluid 7 x 2 mL
Detox Fluid 25 x 2 mL (Spa Use)
Refining Retinol Fluid 7 x 2 mL
Refining Retinol Fluid 25 x 2 mL (Spa Use)
Hyaluron Fluid 7 x 2 mL
Hyaluron Fluid 25 x 2 mL (Spa Use)
Superfruit Fluid 7 x 2 mL
Couperose Fluid 25 x 2 mL (Spa Use)
Superfruit Fluid 25 x 2 mL (Spa Use)
Dark Spot Perfector 30 mL
Scar Cream 75 mL
Good Night Lip Mask 15 mL
Good Night Hand Mask 75 mL
Caviar Luxury Cream 50 mL
Caviar Luxury Cream 150 mL (Spa Use)
Marine Collagen Cream 50 mL
Melafadin Fluid 25 x 2 mL (Spa Use)
Caviar Extract 7 x 2 mL
Caviar Extract 25 x 2 mL (Spa Use)
Anti Wrinkle Booster 7 x 2 mL
Anti Wrinkle Booster 25 x 2 mL (Spa Use)
Marine Collagen Fluid 7 x 2 mL
Marine Collagen Fluid 25 x 2 mL (Spa Use)
Melafadin Fluid 7 x 2 mL
Stem Cell Fluid 7 x 2 mL
Marine Collagen Cream 150 mL (Spa Use)
Sensational Glow Cream 50 mL
Sensational Glow Cream 100 mL (Spa Use)
Probiotics Anti-Pollution Cream 50 mL
Probiotics Anti-Pollution Cream 150 mL (Spa Use)
Magic Glow Serum 30 mL
Stem Cell Fluid 25 x 2 mL (Spa Use)
Dermafleece Mask Collagen Pure
Dermafleece Mask Collage Aloe Vera
Dermafleece Mask Collagen Allantoin Panthenol
Dermafleece Mask Collagen Vitamin C
Dermafleece Mask Collagen Caviar Extract
Dermafleece Mask Collagen Hyaluron
Dermafleece Mask Collagen Fair Skin
Age Defying Cream Mask 200 mL (Spa Use)
Lift Contour Cream Mask 200 mL (Spa Use)
Purifying BHA Serum 30 mL
Purifying BHA Serum 50 mL (Spa Use)
Microsilver Serum 30 mL
Microsilver Serum 50 mL (Spa Use)
Intense Clearing Mask 75 mL
Intense Clearing Mask 200 mL (Spa Use)
Gentle Cleansing Powder 100g
Gentle Cleansing Powder 100g (Spa Use)
Tinted Balancing Cream 50 mL
Tinted Balancing Cream 100 mL (Spa Use)
Balancing Cream 50 mL
Balancing Cream 200 mL (Spa Use)
Brightening Face Cleanser 200 mL
Brightening Face Cleanser 500 mL (Spa Use)
Brightening Face Freshener 200 mL
Brightening Face Freshener 500 mL (Spa Use)
Intensive Face Scrub 50 mL
Rich Nutrient Skin Refiner 50 mL
Rich Nutrient Skin Refiner 150 mL (Spa Use)
Optimal Tinted Complexion Cream 50 mL
Optimal Tinted Complexion Cream 100 mL (Spa Use)
Light Tightening Cream 50 mL
Light Tightening Cream 150 mL (Spa Use)
Intensive Face Scrub 200 mL (Spa Use)
Lifting and Recovery Cream 50 mL
Lifting and Recovery Cream 200 mL (Spa Use)
Vitaforce C Cream 50 mL
Vitaforce C Cream 200 mL (Spa Use)
Retinol Lift 50 capsules
Retinol Lift 150 capsules (Spa Use)
Vitaforce C Skin Complex 30 mL
Vitaforce C Skin Complex 50 mL (Spa Use)
Micellar Skin Tonic 200 mL
Micellar Skin Tonic 500 mL (Spa Use)
Luxury Oil Cleanser 100 mL
Luxury Oil Cleanser 100 mL (Spa Use)
Skin Refining Enzyme Peel 50 mL
Skin Refining Enzyme Peel 150 mL (Spa Use)
Perfect Lift Cream 50 mL
Perfect Lift Cream 150 mL (Spa Use)
Night Recovery Serum 30 mL
Rejuvenating Mask 50 mL
Rejuvenating Mask 200 mL (Spa Use)
Tri-Care Eye Cream 15 mL
Tri-Care Eye Cream 30 mL (Spa Use)
Ceramide Protection 30 capsules
Rich Energy Mask 50 mL
Rich Energy Mask 200 mL (Spa Use)
Rich Eye Contour Cream 15 mL
Rich Eye Contour Cream 30 mL (Spa Use)
Firming Neck and Decollete Cream 50 mL
Firming Neck and Decollete Cream 150 mL (Spa Use)
Age Perfecting Serum 30 mL
Skin Contour Cream 50 mL
Skin Contour Cream 150 mL (Spa Use)
Rich Recovery Cream 50 mL
Rich Recovery Cream 200 mL (Spa Use)
Age Perfecting Serum 50 mL (Spa Use)
Mild Creamy Cleanser 200mL
Mild Creamy Cleanser 500mL (Spa Use)
Radiant Firming Tonic 200mL
Radiant Firming Tonic 500mL (Spa Use)
Mild Face Rub 1.7 oz
Mild Face Rub 7.0 oz (Spa Use)
Hydro Active Gel 1.7 oz
Hydro Active Gel 5.2 oz (Spa Use)
Super Hydrating Cream 1.7 oz
Super Hydrating Cream 5.2 oz (Spa Use)
Hyaluron3 Replenish Cream 1.7 oz
Hyaluron3 Replenish Cream 7.0 oz (Spa Use)
Hyaluron Impulse 50ct
Hyaluron Impulse 150ct (Spa Use)
Deep Xpress Moist Serum 1.0 oz
Deep Xpress Moist Serum 1.7 oz (Spa Use)
Aqualift Eye Gel 0.5 oz
Aqualift Eye Gel 1.0 oz (Spa Use)
Deep Xpress Hydro Mask 2.6 oz
Deep Xpress Hydro Mask 7.0 oz (Spa Use)
Soft Cleansing Mousse 5.0 oz
Soft Cleansing Mousse 5.0 oz (Spa Use)
Soft Soothing Tonic 200 mL
Soft Soothing Tonic 250 mL (Spa Use)
Intense Calming Cream 50 mL
Intense Calming Cream 150 mL (Spa Use)
Intense Calming Serum 1.0 oz
Daily Couperose Serum 1.0 oz
Instant Soothing Mask 75 mL
Instant Soothing Mask 200 mL (Spa Use)
Comfort Eye Care 15 mL
Comfort Eye Care 30 mL (Spa Use)
Neuro Skin Balm 100 mL
Purifying Cleansing Gel 200 mL
Purifying Cleansing Gel 500mL (Spa Use)
Purifying Tonic 200 mL
Purifying Tonic 500 mL (Spa Use)
AHA plus BHA Cleanser 200 mL
AHA plus BHA Cleanser 500 mL (Spa Use)
AHA plus BHA Exfoliator 30 mL
AHA plus BHA Exfoliator 50 mL (Spa Use)
Enzyme Peeling Powder 50g
Enzyme Peeling Powder 100g (Spa Use)
Light Mattifying Cream 50 mL
Light Mattifying Cream 150 mL (Spa Use)
Regulating Retinol Cream 50 mL
Regulating Retinol Cream 150 mL (Spa Use)
AHA Face Cream 50 mL
AHA Face Cream 150 mL (Spa Use)
pH Neutralizer 250 mL
Exfoliator 20 - 50 mL
Exfoliator 30 - 50 mL
Exfoliator 40 - 50 mL
Exfoliator 60 - 50 mL
Thermo Peel Mask Cranberry 300g
Enzyme Peeling Mask 300g
Revigorating Face Mask 150 mL
Herbal Skin Ointment 200 mL
Thermo Face Mask 4 x 440g
Relaxing Massage Cream 200 mL
Mask Activator 500 mL
Mask Activator 1000 mL (Spa Use)
Biocellulose Mask 5ct
Black Detox Bubble Mask 5ct
Massage Fleece Face Pure 1ct
Intense Calming Lotion 50mL
Intense Calming Lotion 150 mL (Spa Use)
Intense Calming Serum 50 mL
2 Phase Melafadin Concentrate 4 x 10 mL
Perfect Radiance Make Up Shade 03
Vitalizing Skin Refiner 50 mL
Vitalizing Skin Refiner 150 mL (Spa Use)
Pro-Lift Cream 50 mL
Pro-Lift Cream 200 mL (Spa Use)
Smooth plus Lift Eye Cream 15 mL
Smooth plus Lift Eye Cream 30 mL (Spa Use)
Have you used any other product(s) of this brand?
Ceramide Protection 90 capsules
Instant Lift Serum 30 mL
Instant Lift Serum 50 mL (Spa Use)
Melafadin Cleansing Powder 60 g
Melafadin Cleansing Powder 100 g (Spa Use)
Melafadin Toner 100 mL
Melafadin Toner 500 mL (Spa Use)
Brightening Exfoliator 50 mL
Brightening Exfoliator 100 mL (Spa Use)
Brightening Night Care 150 mL (Spa Use)
Fair Complexion Serum 30 mL
Brightening Mask 150 mL
Dark Circle Eye Cream 15 mL
Dark Circle Eye Cream 30 mL (Spa Use)
Skin Resurfacing Balm 75 mL
Brightening Day Protection 50 mL
Brightening Day Protection 100 mL (Spa Use)
Brightening Night Care 50 mL
Magic Glow Serum 50 mL
Probiotics Pro-Immune Serum 30 mL
Probiotics Pro-Immune Serum 50 mL (Spa Use)
Irresistible Eye Elixir 15 mL
Face Guard Advanced 30 mL
Face Guard Advanced 50 mL (Spa Use)
Detox Cream 50 mL
Moor Cream Mask 200 mL (Spa Use)
Fruit Peel Cream Mask 200 mL (Spa Use)
Hydrating Cream Mask 200 mL (Spa Use)
Pomegranate Cream Mask 200 mL (Spa Use)
Snow Algae Hydrating 10 x 15g (Spa Use)
Aloe De-Stress 10 x 30g (Spa Use)
Olive Balancing 10 x 30g (Spa Use)
Goji Anti-Oxidant 10 x 30g (Spa Use)
Spirulina Green Mask 10 x 30g (Spa Use)
Detox Cream 200 mL (Spa Use)
Epigenetic Serum 10 mL
Epigenetic Serum 15 mL (Spa Use)
Retinol Lift Serum 30 mL
Retinol Lift Serum 50 mL (Spa Use)
Hyaluron Lift Eye Pads 3 x 2 pcs
Hyaluron Lift Eye Pads 10 x 2 pcs
Acerola Vitamin C Powder Mask 10 x 30g (Spa Use)
Botanica White Mask 10 x 30g (Spa Use)
Dead Sea Black Mask 10 x 30g (Spa Use)
Exfoliation System Cleanser 250 mL
Perfect Radiance Make Up Shade 00
Perfect Radiance Make Up Shade 01
Perfect Radiance Make Up Shade 02
Eye Make Up Remover 100 mL
Eye Make Up Remover 200 mL (Spa Use)
Perfect Cover Cream Shade 01
Perfect Cover Cream Shade 02
Perfect Cover Cream Shade 03
Perfect Cover Cream Shade 04
Perfect Cover Cream Shade 05
Perfect Powder Fixing 30 mL
Refreshing Shower Mousse 200 mL
Hand Care Cream 50 mL
Vitalizing Leg Lotion 75 mL
Vitaforce ACE Body Cream 150 mL
Perfect Bust Formula 75 mL
Perfect Bust Formula 150 mL
Body Contour Booster 150 mL
Body Contour Booster 250 mL (Spa Use)
Silhouette Contouring Cream 150 mL
Silhouette Contouring Cream 250 mL (Spa Use)
24h Body Moisturizer 150 mL
24h Body Moisturizer 250 mL (Spa Use)
Oriental Body Scrub 1000 mL (Spa Use)
3 Salt Body Scrub 1000 mL (Spa Use)
Stimulating Massage Balm 1000 mL (Spa Use)
Grape Seed Massage Oil 500 mL (Spa Use)
Essential Oil Complex 30 mL (Spa Use)
Thermo Body Pack 2000 g (Spa Use)
Creamy Body Pack 1000 g (Spa Use)
3 Tea Body Pack 1000 g (Spa Use)
Cryogenic Alginate (Arctic) 1000 g (Spa Use)
Body Toning Modelage 500 mL (Spa Use)
Body Toning Elixir 500 mL (Spa Use)
After Sun Lotion 150 mL
Active Shower Gel 200 mL
Calming Hydro Gel 50 mL
24-7 Skin Energizer 50 mL
Energizing Eye Roll 15 mL
Long Lasting Deodorant 30 g
Day Cream 50 mL
Day Cream 100 mL (Spa Use)
Purifying Wash plus Shave 75 mL
Night Cream 50 mL
Night Cream 100 mL (Spa Use)
Effect Serum 30 mL
Effect Serum 50 mL (Spa Use)
Eye Cream 15 mL
Eye Cream 30 mL (Spa Use)
Brilliance Shine Elixir 7 x 2 mL
Brilliance Shine Elixir 25 x 2 mL (Spa Use)
Eye Flash Fluid 7 x 15 mL
Eye Flash Fluid 25 x 15 mL (Spa Use)
Instant Soothing Oil 7 x 2 mL
Instant Soothing Oil 25 x 2 mL (Spa Use)
Skin Contour Fluid 7 x 2 mL
Skin Contour Fluid 25 x 2 mL (Spa Use)
Detox Fluid 7 x 2 mL
Detox Fluid 25 x 2 mL (Spa Use)
Refining Retinol Fluid 7 x 2 mL
Refining Retinol Fluid 25 x 2 mL (Spa Use)
Hyaluron Fluid 7 x 2 mL
Hyaluron Fluid 25 x 2 mL (Spa Use)
Superfruit Fluid 7 x 2 mL
Couperose Fluid 25 x 2 mL (Spa Use)
Superfruit Fluid 25 x 2 mL (Spa Use)
Dark Spot Perfector 30 mL
Scar Cream 75 mL
Good Night Lip Mask 15 mL
Good Night Hand Mask 75 mL
Caviar Luxury Cream 50 mL
Caviar Luxury Cream 150 mL (Spa Use)
Marine Collagen Cream 50 mL
Melafadin Fluid 25 x 2 mL (Spa Use)
Caviar Extract 7 x 2 mL
Caviar Extract 25 x 2 mL (Spa Use)
Anti Wrinkle Booster 7 x 2 mL
Anti Wrinkle Booster 25 x 2 mL (Spa Use)
Marine Collagen Fluid 7 x 2 mL
Marine Collagen Fluid 25 x 2 mL (Spa Use)
Melafadin Fluid 7 x 2 mL
Stem Cell Fluid 7 x 2 mL
Marine Collagen Cream 150 mL (Spa Use)
Sensational Glow Cream 50 mL
Sensational Glow Cream 100 mL (Spa Use)
Probiotics Anti-Pollution Cream 50 mL
Probiotics Anti-Pollution Cream 150 mL (Spa Use)
Magic Glow Serum 30 mL
Stem Cell Fluid 25 x 2 mL (Spa Use)
Dermafleece Mask Collagen Pure
Dermafleece Mask Collage Aloe Vera
Dermafleece Mask Collagen Allantoin Panthenol
Dermafleece Mask Collagen Vitamin C
Dermafleece Mask Collagen Caviar Extract
Dermafleece Mask Collagen Hyaluron
Dermafleece Mask Collagen Fair Skin
Age Defying Cream Mask 200 mL (Spa Use)
Lift Contour Cream Mask 200 mL (Spa Use)
Purifying BHA Serum 30 mL
Purifying BHA Serum 50 mL (Spa Use)
Microsilver Serum 30 mL
Microsilver Serum 50 mL (Spa Use)
Intense Clearing Mask 75 mL
Intense Clearing Mask 200 mL (Spa Use)
Gentle Cleansing Powder 100g
Gentle Cleansing Powder 100g (Spa Use)
Tinted Balancing Cream 50 mL
Tinted Balancing Cream 100 mL (Spa Use)
Balancing Cream 50 mL
Balancing Cream 200 mL (Spa Use)
Brightening Face Cleanser 200 mL
Brightening Face Cleanser 500 mL (Spa Use)
Brightening Face Freshener 200 mL
Brightening Face Freshener 500 mL (Spa Use)
Intensive Face Scrub 50 mL
Rich Nutrient Skin Refiner 50 mL
Rich Nutrient Skin Refiner 150 mL (Spa Use)
Optimal Tinted Complexion Cream 50 mL
Optimal Tinted Complexion Cream 100 mL (Spa Use)
Light Tightening Cream 50 mL
Light Tightening Cream 150 mL (Spa Use)
Intensive Face Scrub 200 mL (Spa Use)
Lifting and Recovery Cream 50 mL
Lifting and Recovery Cream 200 mL (Spa Use)
Vitaforce C Cream 50 mL
Vitaforce C Cream 200 mL (Spa Use)
Retinol Lift 50 capsules
Retinol Lift 150 capsules (Spa Use)
Vitaforce C Skin Complex 30 mL
Vitaforce C Skin Complex 50 mL (Spa Use)
Micellar Skin Tonic 200 mL
Micellar Skin Tonic 500 mL (Spa Use)
Luxury Oil Cleanser 100 mL
Luxury Oil Cleanser 100 mL (Spa Use)
Skin Refining Enzyme Peel 50 mL
Skin Refining Enzyme Peel 150 mL (Spa Use)
Perfect Lift Cream 50 mL
Perfect Lift Cream 150 mL (Spa Use)
Night Recovery Serum 30 mL
Rejuvenating Mask 50 mL
Rejuvenating Mask 200 mL (Spa Use)
Tri-Care Eye Cream 15 mL
Tri-Care Eye Cream 30 mL (Spa Use)
Ceramide Protection 30 capsules
Rich Energy Mask 50 mL
Rich Energy Mask 200 mL (Spa Use)
Rich Eye Contour Cream 15 mL
Rich Eye Contour Cream 30 mL (Spa Use)
Firming Neck and Decollete Cream 50 mL
Firming Neck and Decollete Cream 150 mL (Spa Use)
Age Perfecting Serum 30 mL
Skin Contour Cream 50 mL
Skin Contour Cream 150 mL (Spa Use)
Rich Recovery Cream 50 mL
Rich Recovery Cream 200 mL (Spa Use)
Age Perfecting Serum 50 mL (Spa Use)
Mild Creamy Cleanser 200mL
Mild Creamy Cleanser 500mL (Spa Use)
Radiant Firming Tonic 200mL
Radiant Firming Tonic 500mL (Spa Use)
Mild Face Rub 1.7 oz
Mild Face Rub 7.0 oz (Spa Use)
Hydro Active Gel 1.7 oz
Hydro Active Gel 5.2 oz (Spa Use)
Super Hydrating Cream 1.7 oz
Super Hydrating Cream 5.2 oz (Spa Use)
Hyaluron3 Replenish Cream 1.7 oz
Hyaluron3 Replenish Cream 7.0 oz (Spa Use)
Hyaluron Impulse 50ct
Hyaluron Impulse 150ct (Spa Use)
Deep Xpress Moist Serum 1.0 oz
Deep Xpress Moist Serum 1.7 oz (Spa Use)
Aqualift Eye Gel 0.5 oz
Aqualift Eye Gel 1.0 oz (Spa Use)
Deep Xpress Hydro Mask 2.6 oz
Deep Xpress Hydro Mask 7.0 oz (Spa Use)
Soft Cleansing Mousse 5.0 oz
Soft Cleansing Mousse 5.0 oz (Spa Use)
Soft Soothing Tonic 200 mL
Soft Soothing Tonic 250 mL (Spa Use)
Intense Calming Cream 50 mL
Intense Calming Cream 150 mL (Spa Use)
Intense Calming Serum 1.0 oz
Daily Couperose Serum 1.0 oz
Instant Soothing Mask 75 mL
Instant Soothing Mask 200 mL (Spa Use)
Comfort Eye Care 15 mL
Comfort Eye Care 30 mL (Spa Use)
Neuro Skin Balm 100 mL
Purifying Cleansing Gel 200 mL
Purifying Cleansing Gel 500mL (Spa Use)
Purifying Tonic 200 mL
Purifying Tonic 500 mL (Spa Use)
AHA plus BHA Cleanser 200 mL
AHA plus BHA Cleanser 500 mL (Spa Use)
AHA plus BHA Exfoliator 30 mL
AHA plus BHA Exfoliator 50 mL (Spa Use)
Enzyme Peeling Powder 50g
Enzyme Peeling Powder 100g (Spa Use)
Light Mattifying Cream 50 mL
Light Mattifying Cream 150 mL (Spa Use)
Regulating Retinol Cream 50 mL
Regulating Retinol Cream 150 mL (Spa Use)
AHA Face Cream 50 mL
AHA Face Cream 150 mL (Spa Use)
pH Neutralizer 250 mL
Exfoliator 20 - 50 mL
Exfoliator 30 - 50 mL
Exfoliator 40 - 50 mL
Exfoliator 60 - 50 mL
Thermo Peel Mask Cranberry 300g
Enzyme Peeling Mask 300g
Revigorating Face Mask 150 mL
Herbal Skin Ointment 200 mL
Thermo Face Mask 4 x 440g
Relaxing Massage Cream 200 mL
Mask Activator 500 mL
Mask Activator 1000 mL (Spa Use)
Biocellulose Mask 5ct
Black Detox Bubble Mask 5ct
Massage Fleece Face Pure 1ct
Intense Calming Lotion 50mL
Intense Calming Lotion 150 mL (Spa Use)
Intense Calming Serum 50 mL
2 Phase Melafadin Concentrate 4 x 10 mL
Perfect Radiance Make Up Shade 03
Vitalizing Skin Refiner 50 mL
Vitalizing Skin Refiner 150 mL (Spa Use)
Pro-Lift Cream 50 mL
Pro-Lift Cream 200 mL (Spa Use)
Smooth plus Lift Eye Cream 15 mL
Smooth plus Lift Eye Cream 30 mL (Spa Use)
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Manufacturer
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Packer
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Distributor
Date of first use?
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Date of last use?
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Date of first use?
MM slash DD slash YYYY
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Date of last use?
MM slash DD slash YYYY
Do you still have the product?
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Front and Back of Label
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Is this product labeled for single use?
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Expiration Date
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Expiration Date
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Product Identifier
Product Batch No.
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Serial Number
Event reappeared after reintroduction?
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Does not apply
Please add details of the area of the use?
Have you used any other cosmetic products?
Have you changed your skincare routine or skincare products in recent times?
Retailer Information
Retailer Name
Retailer Address 1
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Review And Confirm
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