[Code of Federal Regulations] [Title 21, Volume 8] [Revised as of April 1, 2001] From the U.S. Government Printing Office via GPO Access [CITE: 21CFR803.52] [Page 52-53] TITLE 21--FOOD AND DRUGS CHAPTER I--FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES--(Continued) PART 803--MEDICAL DEVICE REPORTING--Table of Contents Subpart E--Manufacturer Reporting Requirements Sec. 803.52 Individual adverse event report data elements. Individual medical device manufacturer reports shall contain the following information, known or reasonably known to them as described in Sec. 803.50(b), which corresponds to the format of FDA Form 3500A: (a) Patient information (Block A) shall contain the following: (1) Patient name or other identifier; (2) Patient age at the time of event, or date of birth; (3) Patient gender; and (4) Patient weight. (b) Adverse event or product problem (Block B) shall contain the following: (1) Adverse event or product problem; (2) Outcomes attributed to the adverse event, e.g., death; or serious injury, that is: (i) Life threatening injury or illness; (ii) Disability resulting in permanent impairment of a body function or permanent damage to a body structure; or (iii) Injury or illness that requires intervention to prevent permanent impairment of a body structure or function; (3) Date of event; (4) Date of report by the initial reporter; (5) Description of the event or problem to include a discussion of how the device was involved, nature of the problem, patient followup or required treatment, and any environmental conditions that may have influenced the event; (6) Description of relevant tests, including dates and laboratory data; and (7) Other relevant patient history including pre-existing medical conditions. (c) Device information (Block D) shall contain the following: (1) Brand name; (2) Type of device; (3) Manufacturer name and address; (4) Operator of the device (health professional, patient, lay user, other); (5) Expiration date; (6) Model number, catalog number, serial number, lot number or other identifying number; (7) Date of device implantation (month, day, year); (8) Date of device explantation (month, day, year); (9) Whether the device was available for evaluation, and whether the device was returned to the manufacturer, and [[Page 53]] if so, the date it was returned to the manufacturer; and (10) Concomitant medical products and therapy dates. (Do not list products that were used to treat the event.) (d) Initial reporter information (Block E) shall contain the following: (1) Name, address, and phone number of the reporter who initially provided information to the user facility, manufacturer, or distributor; (2) Whether the initial reporter is a health professional; (3) Occupation; and (4) Whether the initial reporter also sent a copy of the report to FDA, if known. (e) All manufacturers (Block G) shall contain the following: (1) Contact office name and address and device manufacturing site; (2) Telephone number; (3) Report sources; (4) Date received by manufacturer (month, day, year); (5) Type of report being submitted (e.g., 5-day, initial, supplemental); and (6) Manufacturer report number. (f) Device manufacturers (Block H) shall contain the following: (1) Type of reportable event (death, serious injury, malfunction, etc.); (2) Type of followup report, if applicable (e.g., correction, response to FDA request, etc.); (3) If the device was returned to the manufacturer and evaluated by the manufacturer, a summary of the evaluation. If no evaluation was performed, provide an explanation why no evaluation was performed; (4) Device manufacture date (month, day, year); (5) Was device labeled for single use; (6) Evaluation codes (including event codes, method of evaluation, result, and conclusion codes) (refer to FDA ``Coding Manual for Form 3500A''); (7) Whether remedial action was taken and type; (8) Whether use of device was initial, reuse, or unknown; (9) Whether remedial action was reported as a removal or correction under section 519(f) of the act (list the correction/removal report number); and (10) Additional manufacturer narrative; and/or (11) Corrected data, including: (i) Any information missing on the user facility report or distributor report, including missing event codes, or information corrected on such forms after manufacturer verification; (ii) For each event code provided by the user facility under Sec. 803.32(d)(10) or a distributor, a statement of whether the type of the event represented by the code is addressed in the device labeling; and (iii) If any required information was not provided, an explanation of why such information was not provided and the steps taken to obtain such information.