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Form Approved: OMB No. 0910-0291, Expires: 6/30/2015 See OMB statement on reverse. U.S. Department of Health and Human Services Food and Drug Administration For use by user-facilities, importers,
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Form FDA 3500a MedWatch is a form used for healthcare professionals, patients, and consumers to report serious adverse events or product problems with medical products to the FDA.
Healthcare professionals, patients, and consumers are required to file Form FDA 3500a MedWatch if they encounter serious adverse events or product problems with medical products.
Form FDA 3500a MedWatch can be filled out online on the FDA's website or by submitting a paper form by mail or fax. Detailed instructions are provided on the form itself.
The purpose of Form FDA 3500a MedWatch is to allow for the reporting of serious adverse events or product problems with medical products to the FDA in order to ensure patient safety.
Information such as patient demographics, product information, adverse event details, and contact information of the reporter must be reported on Form FDA 3500a MedWatch.
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