Report an adverse incident

PATIENTS and/or health professionals, report here:

Patient information

Name

Gender
MaleFemale

Date of birth

Email

Date of the beginning of the incident

Description of the incident

Consequences of the incidente

Medical device identification

Name of the medical device

Code or model

Lot number

Location of the medical device

Select the location of the medical device
On the patient’s propertyDestroyedDiscontinuedReturned to the manufacturerReturned to the pharmacyUnknown

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Health professionals can also report here:

Download the Official Format by COFEPRIS

Fill the format with the solicited data (3 sheets long)

Save the changes and upload the file here:

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