Formulaire

Materiovigilance: Reporting of an incident or risk of an incident involving a medical device (Form 10246*05)

Cerfa 10246*05

Allows you to report an incident or risk of an incident with a medical device to the National Agency for the Safety of Medicines and Health Products (ANSM). Alert Help Sheet depending on the severity of the incident.

    Fill out the form

    To whom shall I send this form ?

    J'ai réalisé une démarche administrative

    Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

    Je donne mon avis

    Émetteur du formulaire administratif : Ministry of Health

    Verified 19 March 2018 - Directorate for Legal and Administrative Information (Prime Minister)