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Free Medical Devices Template

Free MDR Vigilance Report

Regulatory vigilance report assessment for [event_id]

Event Summary Device Details Patient or User Impact Reportability Assessment Investigation Status Corrective Actions Submission Controls

MDR Vigilance Report

Use this template to regulatory vigilance report assessment for [event_id].

Template Metadata

Field Details
Category Medical Devices
Owner [Team or owner]
Version [Version number]
Effective Date [Date]
Review Cycle [Monthly / Quarterly / Annual / Event-based]
Status [Draft / In Review / Approved]

Event Summary

State event ID, awareness date, source, country, complaint link, and concise event description.

Item Details Owner Status
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]

Notes

[Add context, assumptions, exceptions, evidence links, screenshots, calculations, or reviewer comments.]

Device Details

Identify device name, model, UDI, lot or serial number, software version, and distribution status.

Item Details Owner Status
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]

Notes

[Add context, assumptions, exceptions, evidence links, screenshots, calculations, or reviewer comments.]

Patient or User Impact

Describe injury, treatment, outcome, exposure, and whether the device was available for evaluation.

Item Details Owner Status
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]

Notes

[Add context, assumptions, exceptions, evidence links, screenshots, calculations, or reviewer comments.]

Reportability Assessment

Document decision logic for death, serious injury, malfunction, serious public health threat, and regional criteria.

Item Details Owner Status
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]

Notes

[Add context, assumptions, exceptions, evidence links, screenshots, calculations, or reviewer comments.]

Investigation Status

Summarize current findings, DHR review, returned device analysis, and root cause status.

Item Details Owner Status
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]

Notes

[Add context, assumptions, exceptions, evidence links, screenshots, calculations, or reviewer comments.]

Corrective Actions

List containment, CAPA, field action, labeling, or risk file updates.

Item Details Owner Status
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]

Notes

[Add context, assumptions, exceptions, evidence links, screenshots, calculations, or reviewer comments.]

Submission Controls

Define report type, authority, due date, submitter, follow-up schedule, and records retained. Use regulatory assessment language and avoid unsupported conclusions.

Item Details Owner Status
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]
[Item or requirement] [Describe the relevant detail, evidence, or decision] [Owner] [Open / Complete]

Notes

[Add context, assumptions, exceptions, evidence links, screenshots, calculations, or reviewer comments.]

Review and Signoff

Document review conclusions, approvals, unresolved items, and next review date.

Role Name Date Notes
Preparer [Name] [Date] [Notes]
Reviewer [Name] [Date] [Notes]
Approver [Name] [Date] [Notes]

Template Structure

What the MDR Vigilance Report Includes

Use this medical devices template as a starting point, then customize each section to match your internal workflow, evidence, and signoff needs.

1

Event Summary

State event ID, awareness date, source, country, complaint link, and concise event description.

2

Device Details

Identify device name, model, UDI, lot or serial number, software version, and distribution status.

3

Patient or User Impact

Describe injury, treatment, outcome, exposure, and whether the device was available for evaluation.

4

Reportability Assessment

Document decision logic for death, serious injury, malfunction, serious public health threat, and regional criteria.

5

Investigation Status

Summarize current findings, DHR review, returned device analysis, and root cause status.

6

Corrective Actions

List containment, CAPA, field action, labeling, or risk file updates.

7

Submission Controls

Define report type, authority, due date, submitter, follow-up schedule, and records retained. Use regulatory assessment language and avoid unsupported conclusions.

Recommended Structure

Write a Medical Device MDR/Vigilance Report assessment. Structure with these Markdown sections:

Event Summary

State event ID, awareness date, source, country, complaint link, and concise event description.

Device Details

Identify device name, model, UDI, lot or serial number, software version, and distribution status.

Patient or User Impact

Describe injury, treatment, outcome, exposure, and whether the device was available for evaluation.

Reportability Assessment

Document decision logic for death, serious injury, malfunction, serious public health threat, and regional criteria.

Investigation Status

Summarize current findings, DHR review, returned device analysis, and root cause status.

Corrective Actions

List containment, CAPA, field action, labeling, or risk file updates.

Submission Controls

Define report type, authority, due date, submitter, follow-up schedule, and records retained.

Use regulatory assessment language and avoid unsupported conclusions.

Example Filled Template

MDR/Vigilance Report Assessment - EV-2026-031

Event Summary

A clinician reported infusion pump IP-700 stopped during therapy in Germany on 2026-04-18.

Device Details

Model IP-700, serial IP700-22610, software version 4.2.1.

Patient or User Impact

Therapy was restarted on a backup pump with no reported injury.

Reportability Assessment

The malfunction is potentially reportable because recurrence could cause serious injury.

Investigation Status

Returned device analysis is pending; DHR review found no production nonconformance.

Corrective Actions

Firmware review is opened under CAPA-2026-019.

Submission Controls

Initial EU vigilance report is due within 10 calendar days of awareness.

Skip Manual Drafting

Generate a MDR Vigilance Report from a Video

Record a walkthrough, training session, or process demonstration. Docsie AI turns it into structured documentation using this template as the starting framework.

Use the template manually, or let Docsie generate the first draft from source footage.

DOCX, PDF, and Markdown downloads
Works with process and training videos

Template FAQ

MDR Vigilance Report FAQ

Common questions about using and generating a mDR Vigilance Report.

Using This Template

Q: What is a mDR Vigilance Report?

A: A mDR Vigilance Report is a structured document for regulatory vigilance report assessment for [event_id].

Q: Can I download this mDR Vigilance Report as Word or PDF?

A: Yes. This page includes free downloads in DOCX, PDF, and Markdown formats so you can edit, share, or import the template into your documentation system.

Q: Can Docsie generate this from a video?

A: Yes. Upload a process walkthrough, training recording, or screen capture to Docsie, then use this template structure to generate a first draft automatically.