As Ilisa Watson lay on her hospital bed after vomiting blood, her phone kept buzzing.

It was Total Compounding Pharmaceuticals (TCP), a pharmacy she’d bought weight loss drugs from, trying to sell her more of the very medication that she believes made her so sick.

A month earlier, Ms Watson was prescribed the diabetes drug Ozempic by a doctor for weight loss.

But when she couldn’t find the real thing, a friend recommended she try the compounded version.

She was taken aback by the colour of the injectable liquid when it arrived in the post.

Ilisa Watson felt violently unwell within hours of taking the compounded medication.(Supplied: Ilisa Watson)

“It was blood red; like, really, really red, which I thought was strange,” Ms Watson said, but as it came from what she thought was a legitimate pharmacy, she injected it.

Within hours she felt violently unwell. Within weeks she was vomiting blood.

“It was like a balloon was sitting on my chest,” she recalled. 

She was admitted to the Royal Hobart Hospital for treatment.

Doctors couldn’t get to the bottom of what was causing the reaction or why anti-nausea medication wasn’t helping.

“They were like, you know, maybe I just got a bad batch or something,” she said.

While she was receiving treatment, TCP staff kept contacting her to sell her more medication. 

“When I was … literally in hospital on the bed, they said, ‘your scripts are about to run out, do you want to order some more?’,” adding they were offering her more medication without a script.

“I was ignoring the text messages and then I was blocking numbers. I finally answered one and I was like, ‘can you please delete my number?’

“I told them that I’ve got really sick and that I’d had a reaction to the medication and she says, ‘oh no worries’.”

But the texts continued. 

‘He was so greedy’

Ms Watson is among dozens of patients who reached out to the ABC after a Four Corners’ program revealed TCP was illegally manufacturing and selling replica diabetes drugs, Ozempic and Mounjaro, throughout Australia and exporting them overseas.

Many are now horrified they have no idea what they were injecting into their bodies or the conditions under which the medication was manufactured. 

They want answers about how the unregistered pharmacy was able to operate and export replica prescription medications without a license. 

The ABC’s investigation found the man taking the money in exchange for the drugs was NSW-registered pharmacist Emad Azzer, who since our reporting, has been suspended from practicing as a pharmacist altogether.

TCP targeted doctors worldwide via fax, with advertising material promising cheap compounded versions of weight loss medications that many of their patients wanted. 

Faxes like these were sent out to GPs.(Supplied)

In Australia, compounding pharmacies are meant to fill a gap in the market, providing one-off medications for patients with a script when there’s no commercial product available. 

They aren’t allowed to manufacture medications in bulk and the drugs they produce aren’t checked for safety, quality and efficacy by the regulator, the Therapeutic Goods Administration (TGA). 

With the popularity of weight loss drugs exploding, and the brand name medications like Ozempic in shortage, many legitimate compounding pharmacies started producing replica versions of the drugs which are widely sold by telehealth platforms. 

However, TCP should never have been selling the weight loss products at all, because it wasn’t a registered pharmacy and Mr Azzer was banned from compounding medications and selling them.

Ms Watson is furious Mr Azzer was allowed to operate in Australia. 

“He would have known that he could have made people very sick and he literally was so greedy and just kept doing it,” she said.

‘I feel let down’

When Samantha* read about TCP via the ABC’s investigation, her stomach dropped. 

She immediately recognised the red vials — she’d been injecting them for weeks, but hadn’t told anyone about it.

The Adelaide woman was prescribed diabetes drug Mounjaro by a specialist who told her losing weight could help her sleep apnoea. 

With the brand name medications hard to find, her specialist handed over a fax advertisement from TCP for a compounded version of Tirzepatide (the active ingredient in Mounjaro), and suggested she try the pharmacy.

“They requested that the specialist fax the script from their rooms and just that in itself gave me a bit of confidence initially that they were legit,” she said. 

Samantha* worries she may have suffered permanent nerve damage.(ABC News: Brendan Esposito)

Within weeks of injecting the medication, she noticed a strong tingling sensation, and had constant pins and needles in her fingers.

“It was just making my hands feel really uncomfortable and I felt like I had to keep shaking them to sort of relieve the sensation,” she said. 

The condition, known as peripheral neuropathy, can cause permanent nerve damage. 

It was the same unusual side effect a doctor interviewed by Four Corners noticed in another patient using compounded weight loss drugs from TCP. 

That patient had elevated B6 levels that couldn’t be explained. It was suspected the compounded medication from TCP could be the cause. 

“It was just by chance that I was flipping through on my phone and I came across your last story. Otherwise, I’d still be injecting weekly,” she said.

While it’s impossible to know if the symptom was caused by the medication from TCP, she worries she may have suffered permanent nerve damage.

“I think it’s really bad in such an informed and regulated country that we’re experiencing situations like this and I just feel a bit let down.”

‘I felt like I was slowly dying’

Michelle Gerathy from Logan, south of Brisbane, lost 20kg while taking compounded weight loss medication from TCP after her GP gave her the fax advertisement too.

“I started taking it straight away, and it really affected me. I don’t know what it was doing, it was making me out of breath. Just standing up from my bed I would get dizzy,” she said. 

Michelle Gerathy blacked out shortly after taking the medication, falling and hitting her head.(Supplied: Michelle Gerathy)

Earlier this year, she said she blacked out shortly after injecting the medication, falling and injuring her eye.

While it is impossible to know if the medication was responsible, Ms Gerathy is concerned about what she was injecting into her body. 

“I felt like I was slowly dying … it cut every bit of appetite.

“My eye is still so bad and scarred up. I’m worried I have done permanent damage,” she said. 

Queensland-based Business consultant Phillip Beresford is worried too. 

He had been taking compounded weight loss drugs from TCP on recommendation from his GP for a few weeks when he first noticed bruising and redness at the injection site that wouldn’t go away.

Phillip Beresford suffered bruising and pain for weeks after he injected the compounded medication.(Supplied: Phillip Beresford)

“The doctor said, ‘you are having an allergic reaction and you better stop it’,” he said.

“If you ever had a heat rash where your skin becomes sensitive to the touch, a reaction to poison ivy … it was like that.”

Several other patients told the ABC they experienced rashes, bruising and swelling at the injection site, severe nausea and vomiting and bleeding gums after injecting TCP-compounded medication.

It’s not known what conditions TCP was manufacturing the compounded medications in or where the active ingredients were being sourced from. 

Authorities continue investigations as Azzer registers overseas

In a statement released last month, the TGA said it would “continue to dedicate resources to investigate this matter and take appropriate enforcement action against anyone found to have breached the law”.

The agency raided Mr Azzer’s home 48 hours after the ABC passed on the findings of our investigation. The TGA took vials of the red liquid, packaging and documents from the property. 

It said the warrant and seizure were part of an “ongoing investigation into the alleged unlawful manufacture, supply and export of therapeutic goods, including prescription-only medicines”. 

The TGA is investigating what it described as “a serious breach of trust” that allowed the compounded drugs to be illegally sold around the world for years.

“This included medical professionals in Australia and overseas being sent faxes promoting the medicines,” it noted.

“Not only have health professionals been duped into believing this was a legitimate pharmacy, but they have then referred their patients to have their prescriptions filled.”

Tests by the TGA also found vials from TCP had 10 times the amount of vitamin B12 than what was advertised on the label, raising doubts about the quality and safety of the medication.

Separately, the regulator has been consulting on a ban stopping compounding pharmacists making their own versions of weight loss drugs. An outcome is expected in the coming weeks.

Despite ongoing investigations into TCP, Mr Azzer last month begun to register companies in the UK under the same name as those he used to accept money for the replica weight loss drugs in Australia.

While Mr Azzer is nowhere to be seen, TCP appears to still be operating, at least for customers in the lucrative US market.

Pharmacist Emad Azzer walks in the Sydney CBD holding a duffel bag over his shoulder.(Four Corners)

The ABC has learned specialists and primary care physicians at multiple established hospitals and clinics from Texas, to New Jersey, Kansas City, San Francisco, Los Angeles and Alabama have recommended patients use TCP after receiving faxes advertising the compounded weight loss medications.

US patients, who were shocked to discover the medications they ordered were shipped from Australia, told the ABC they are now considering launching legal action against the pharmacy. 

Last week, several US customers contacted the ABC to say they had received messages from the pharmacy trying to sell them more compounded weight loss drugs.

As recently as Friday, the company was also contacting Australian customers to facilitate orders.

“It’s completely nuts,” one former patient told the ABC.

“I can’t believe they are back at it again”. 

Mr Azzer, whose whereabouts are unknown, has not responded to repeated requests for comment. 

The TGA did not respond to a request for comment but previously said: “members of the public who wish to provide evidence to the TGA on this matter directly can send an email through to investigators at [email protected].”

*not her real name.