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Form Approved: OMB No. 09100291, Expires: 6/30/2015 See PRA statement on reverse. U.S. Department of Health and Human ServicesMEDWATCHFor VOLUNTARY reporting of adverse events, product problems and product
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Form FDA Safety Information is a form required by the Food and Drug Administration (FDA) for reporting safety information about regulated products.
Manufacturers, distributors, and other entities involved in the production and distribution of regulated products are required to file Form FDA Safety Information.
Form FDA Safety Information can be filled out electronically on the FDA's website or submitted in paper form by mail or fax.
The purpose of Form FDA Safety Information is to ensure that the FDA is promptly informed of any safety issues related to regulated products, so that appropriate actions can be taken to protect public health.
Information such as product name, description of safety issue, date of occurrence, and contact information for the person reporting the issue must be reported on Form FDA Safety Information.
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