Medical Device Complaints

If you have concerns or problems relating to product quality, please complete the form below. 

A member of the Quality Department will contact you directly following receipt of the complaint.
For us to complete a full investigation, it is important that you retain the product/samples until contacted by one of our Quality Department Representatives, who will acknowledge receipt of the complaint and provide a complaint reference number.

Please do not send any products/samples to us without having been contacted by our Quality Department.

Section 1: Customer/Complaint Details
Section 1: Customer/Complaint Details
Institute/Hospital/Clinic/Company: *
Contact Person: *
Department:
Email: *
Address: *
Contact Phone Number: *
Complaint Source: *
If end user, please provide Job Title:
Section 2: Product Safety Information
Section 2: Product Safety Information
Product Code: *
Product Description (Including Pack Size): *
Lot/Batch Number:
Number of identical events with the same lot/batch number:
Is the sample/photographic evidence available? *
Quantity of defective items: *
We require a complete decontamination certificate before authorising the return of used samples.
We require a complete decontamination certificate before authorising the return of used samples.
Section 3: Event Description
Section 3: Event Description
Please describe the nature of the complaint including any details of the event, when the issue was first identified and what the product was being used for: *
Section 4: Patient Safety Data
Section 4: Patient Safety Data
Time of the event: *
Procedure date: *
Event activity: *
Did the event lead to complications for the user or patient which required medical intervention? *
If yes, please provide details of methods of medical intervention required:
Were the Competent Authority notified? *
If yes, reported by:
Date reported:
Customer Authority Reference:
Our Privacy Notice and how we process personal data, can be found at b2b.mediq.co.uk
Our Privacy Notice and how we process personal data, can be found at b2b.mediq.co.uk