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MedWatch Voluntary Report

  1. About Problem

  2. About Device

  3. About Product

  4. About Patient

  5. About Reporter

  6. Review & Submit

About Problem
* Required Information
 

Please select the cause of the problem that applies below: *


  • Prescription or over-the-counter medicine
  • Biologics, such as human cells and tissues used for transplantation (for example: tendons, ligaments, and bone) and gene therapies
  • Nutrition products, such as vitamins and minerals, herbal remedies, infant formulas, and medical foods
  • Foods (including beverages and ingredients added to foods)
  • Cosmetics or make-up products

  • Any health-related test, tool, or piece of equipment
  • Health-related kits, such as glucose monitoring kits or blood pressure cuffs
  • Implants, such as breast implants, pacemakers, or catheters
  • Other consumer health products, such as contact lenses, hearing aids, and breast pumps
 
What kind of problem was it?

(Check all that apply)




 
Did any of this happen?

(Check all that apply)






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*

(Include as many details as possible)


 

(Include dates)


 
:
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