NOTE:This portal is intended to gather information on registered Medical Devices and its respective Manufacturer/Supplier/Others in order to strengthen the MvPI.

1.A TYPE OF SUBMISSION

1.B FOR IPC USE ONLY ON ORIGINAL SUBMISSIONS

IPC Reference No: Date:

2A. TYPE OF ESTABLISHMENT

IF OTHER PLEASE SPECIFY:
A1. REGISTERED OFFICE NAME: A5. PARENT COMPANY NAME(if any):
A2. REGISTERED OFFICE ADDRESS: A6. COMPANY REGISTRATION NUMBER:
A3. CITY: A4. STATE: A7. POSTAL CODE: A8. COUNTRY:

3. DETAILS OF MEDICAL DEVICE

Sl. No.NAME OF MEDICAL DEVICEUMDN/GMDN CODE OF DEVICENotified/Not Notified(if Notified, Mention class)Model NumberRegulatory Status
4.A ESTABLISHMENT AUTHORIZED INDIVIDUAL NAME: 4.B ALTERNATIVE AUTHORIZED INDIVIDUAL NAME:
A1.DESIGNATION: B1.DESIGNATION:
A2.PHONE NO/MOBILE NO. B2.PHONE NO/MOBILE NO.
A3.EMAIL: B3.EMAIL:
INSTRUCTIONS:

Details are sought for identifying the voluntary medical device manufacturer/distributor ready to contribute in Materiovigilance Program of India.

  • Type in CAPITAL LETTERS
  • Add extra row, if the space is limited to fill information.
  • Mention NA (Not Applicable) rather than leaving a field blank.