Safety Incident Report Form - Meden-Inmed - Rehabilitation Products & Supplies

If you have observed any irregularities or issues regarding the use of a Meden-Inmed product, please complete this form. Your incident report helps us address problems promptly and improve the quality and safety of our products. Please fill out the form carefully so that we can take appropriate action as quickly as possible. All incident reports are handled with the utmost seriousness.

This incident report may concern:

Damage or malfunction of the product
Safety concerns related to product use
Any adverse reactions or health problems associated with the product

Please include any details that may help resolve the issue (e.g., photos of the damage, copies of invoices, medical documents, etc.).

1. Contact Details of the Person Submitting the Report:

Full Name (*)
Email Address (*)

Telephone Number

Preferred Contact MethodEmailTelephone

2. Product Details:

Product Name (*)
Serial Number or ID (*)
Date of Purchase (*)

3. Description of the Incident/Complaint:

Detailed Description of the Problem (*)
Was the problem life-threatening?NoYes

Nature of the ProblemProduct functionInstructionsOther aspect

4. Attachments:

Please attach any files that may help with the report (e.g., a photo of the damage, proof of purchase, or a document illustrating the problem).
Allowed file formats: *.jpg, *.png, *.jpeg.
Maximum file size: 5 MB.

Select fileNo file selected

5. Personal Data Protection:

The administrator of your personal data is Meden-Inmed with its registered office in Koszalin (75-847) at 2 Wenedów Street. The Administrator can be contacted in writing at the following address:
2 Wenedów Street, 75-847 Koszalin
Phone: +48 (94) 347 10 40
E-mail: meden@meden.com.pl
Your personal data will be processed solely for the purpose of handling inquiries submitted via this form. This processing is based on Article 6(1)(c) of the GDPR (the controller's obligation), in accordance with Regulation (EU) 2023/988 of the European Parliament and of the Council on general product safety, to manage reports of dangerous products. For more information about the processing of your personal data, including your rights, please refer to our Privacy Policy.

I have read the Privacy Policy (*)

6. Confirmation of Notification:

I confirm that the information provided is true. (*)

(*) Required field

Updated: 27-02-2025, 08:33