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COMPLAINT FORM

Complaint Form

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What is a Complaint Form?

A medical device complaint form is a document used to report issues or adverse events related to the use of a medical device. It typically includes sections for the complainant’s contact information, a detailed description of the problem, and any relevant device information such as model and serial number. The form also provides space for documenting any actions taken to address the complaint and the outcome of those actions. This helps ensure that all complaints are thoroughly investigated and addressed to maintain patient safety and device efficacy.

 

Tips on completing a Complaint Form:

Accurately and thoroughly completing a complaint form is essential for addressing issues with medical devices promptly and effectively. Here are some key tips to help you ensure that all necessary information is included, facilitating a swift resolution for any reported concerns:

  1. Describe the issue in detail, such as when the deficiency was noticed, how often it happens and any symptoms or malfunctions observed.
  2. Attach supporting documents including photos, videos, or any other evidence that can help illustrate the issue.
  3. Request return of the deficient device to conduct a root cause investigation. At minimum, review the device history record to determine if any deviations occurred during manufacture.

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FAQ About Complaint Forms

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