About the reporter
The minimum information you must provide is your name and address and where you work.
If you would like a copy of your report to be emailed to you, or if you would like to send a copy to someone else (e.g. your Trust’s Risk Manager or Medical Device Liaison Officer), you may enter the relevant email addresses in the spaces provided.
Any local reference number assigned to the report should also be provided here. This will help ensure that multiple reports from a single source are not confused.
About the device
You must also indicate which form you wish to complete. The general medical device report form may used for reporting any device related adverse incident.
The other forms relate to specific named device types. The different and additional information requested on these forms will help MHRA’s device specialists address the problem with the device more readily.
Please don’t delay submitting your report if all relevant information is not to hand. You may always submit additional information when it becomes available.