Radiopharmaceutical Defects Report Form
Date of Incident
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Isotope Generator Manufacturer
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Isotope Generator Product Name
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Isotope Generator Lot Label
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Radiopharmaceutical Manufacturer
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Radiopharmaceutical Product Name
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Radiopharmaceutical Lot Label
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Give brief details of materials, sources, preparation, storage
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Has the MCA Defective Medicines Centre been informed? (0171 273 0574)
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Radiopharmaceutical Defects
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If other Radiopharmaceutical Defect please specify
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Detailed Description of the Problem:
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Any relevant clinical details of the patient:
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Action Taken:
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Full Name
Fullname must contain only a-z,A-Z characters
Title
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Email Address
Please add a valid e-mail address.
Department
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Address
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TelephoneNumber
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Fax Number
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