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Patient Safety Surveillance and Improvement System Reportable Adverse Event Report Submit no later than (7) seven calendar days from discovery of eventless complete all sections of this form by printing
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How to fill out reportable adverse event

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Step 1: Obtain and complete the reportable adverse event form.
02
Step 2: Provide detailed information about the adverse event, including the date, location, and description of the event.
03
Step 3: Identify any potential contributing factors or causes of the adverse event.
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Step 4: Include information about any individuals involved in the event, such as patients, healthcare providers, or witnesses.
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Step 5: Submit the completed report to the appropriate regulatory authority or designated reporting entity.
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Step 6: Follow up as necessary to provide any additional requested information or updates on the event.

Who needs reportable adverse event?

01
Reportable adverse events need to be reported by healthcare providers, pharmaceutical companies, medical device manufacturers, and any other entities involved in the healthcare industry.
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A reportable adverse event is an incident that occurs during the use of a product (such as medical devices or drugs) that results in harmful effects, including injury or death, and must be reported to regulatory authorities.
Manufacturers, healthcare professionals, and in some cases, patients are required to file reportable adverse events to regulatory authorities.
To fill out a reportable adverse event, collect all relevant information about the incident, including details of the event, the product involved, patient information, and any medical interventions performed. Then complete the specific reporting form required by the regulatory authority.
The purpose of reporting adverse events is to identify potential safety issues, monitor product performance, and ensure patient safety through regulatory oversight.
Information that must be reported includes the patient's demographics, description of the adverse event, product details (name, lot number), date of the event, and any medical intervention required.
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