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qms_version 2.2.0
sop_id CSC PR.012
sop_version 2.0.1
template_id CSC F.006
template_version 2.0.1

Urgent Field Safety Notice

General

Template ID CSC F.006
Template Version 2.0.1
QMS Version 2.2.0
SOP ID CSC PR.012
SOP Version 2.0.1
Regulatory References
Author
Approval

Commercial name of the affected product

FSCA-identifier (e.g. date)

Type of action (e.g. chapter 4 definition of a FSCA).


Date:

Attention:

Details on affected devices:

Specific details to enable the affected product to be easily identified e.g. type of device , Application name and version numbers of affected devices.

Insert or attach list of individual devices. Where possible add a reference to a manufacturers' website e.g. the CSC Project GitHub Repository.

Description of the problem:

A factual statement explaining the reasons for the Field Safety Corrective Action (FSCA), including description of the device deficiency or malfunction, clarification of the potential hazard associated with the continued use of the device and the associated risk to the patient, user or other person. Any possible risk to patients associated with previous use of affected devices.

Advise on action to be taken by the user:

Include, as appropriate:

  • identifying and quarantining the device
  • description of how the application will be updated, or removed from clinical workflows
  • timelines
  • Confirmation form to be sent back to the manufacturer if an action is required e.g. removal of application from clinical use

Transmission of this Field Safety Notice: (if appropriate)

This notice needs to be passed on all those who need to be aware within your organisation or to any organisation where the potentially affected devices have been transferred. (If appropriate)

Please transfer this notice to other organisations on which this action has an impact. (If appropriate)

Please maintain awareness on this notice and resulting action for an appropriate period to ensure effectiveness of the corrective action. (if appropriate)

Contact reference person:

{Name / organisation, address, contact details.}

The undersign confirms that this notice has been notified the appropriate Regulatory Agency (Closing paragraph)

Signature