In this form, enter the information provided by ANSM (National Agency for the Safety of Medicines and Health Products) as part of top-down medical device vigilance, which will be used to take the report into account.

 

Name of the report

• Internal reporting no: Code of the information for tracking in CARL Source.
• Title: Name of the report.
• Issuer: Agent responsible for the report.
• Addressee: Agent in charge of taking the report into account.  
• Creation date: For information purposes only, entry date of medical device vigilance.
• Desired end date: Date by which the actions must be completed.
• Organization: Organization concerned.

 

Medical devices in question

• Model: Model of the equipment in question.
• Family: Family of models concerned.

Provide any additional information desired in the text field.

 

Expected actions

• Text references: Indicate where a full description of the medical device vigilance can be found.
• Actions to be taken: Free text specifying the content of the work orders to be carried out.