TEST FDA RMA PAGE

RMA Request Form

Model number, part number, or product name

Is this product used for medical purposes?

Yes

You MUST select “YES” if this solution is being used in a medical application or with one of Myron L® Company’s medical device products.

Health Risk Assessment

FDA regulations require us to ask if the use of this product caused harm, is causing harm, or is creating an imminent risk of harm to a patient or user.

Did use of the product pose any risk to the patient's or user's health?

Yes

If so, you MUST select YES.

Please check the box of the Class that best corresponds to the adverse event.

Class I (Serious Adverse Event): A situation in which the use of or exposure to the product has caused or will cause serious or permanent adverse health consequences or death of a Patient or User.

Class II (Non-Serious Adverse Event): A situation in which there is a reasonable probability that use of or exposure to the product will cause or has caused a temporary medically or reversible adverse health consequences to a Patient or User.

Class III (No Risk): A reported event or complaint was determined NOT to represent a situation in which use of or exposure to the product has caused an adverse health consequence and is not likely to in the future.

Adverse Event Description

Serial Number

Full Name

Position

Company

Department/Division

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Fax Number

Reason for Return

Do you require certificates traceable to NIST?

Yes

Send Us A Message

Send us a message directly through our website.

Founded in 1957, the Myron L^® Company is one of the leading manufacturers of water quality management instruments in the world.

Warranty & Service Policy

Contact

2450 Impala Drive
Carlsbad, CA 92010-7226

Tel.: 1-760-438-2021
Fax: 1-760-931-9189

info@myronl.com

Warning

These products can expose you to chemicals including Di(2-ethylhexyl)phthalate (DEHP), which is known to the State of California to cause cancer and birth defects or other reproductive harm. For more information go to www.P65Warnings.ca.gov.

TEST FDA RMA PAGE

Health Risk Assessment

Send Us A Message

Contact

Warning

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