| Severity |
Select a severity. You can select Low, Medium, High, or Urgent. |
| Location | Type the name of the required location, or click and select a location from the Search Results page. |
| Device Deficiency Confirmed | Select Yes if problem with the device is confirmed. Otherwise, select No. |
| Method | Click and select a method code from the Structure View page. |
| Results | Click and select a result code from the Structure View page. |
| Conclusion Code | Click and select a conclusion code from the Structure View page. |
| Remedial Action Taken | Describe the remedial actions taken to evaluate the event. |
| Further Investigation Required | Select Yes if further investigation is required. Otherwise, select No. |
| Rationale | Type the reason for completing the evaluation. |
| Responsible Investigator | Type the name of the investigator, or click and select an investigator from the Search Results page. |
| Completion Date | Click and select the evaluation completion date. You can select today's date or a past date. |
| Risk Analysis Required | Select Yes if risk analysis is required. Otherwise, select No. |
| Comments | Type the reason for selecting the risk analysis requirement. |
| Malfunction | Select Yes if the problem occurred due to reported item malfunction. Otherwise, select No. |
| Packaging/Labeling | Select Yes if the problem occurred due to a packaging or labeling issue. Otherwise, select No. |
| Use Error | Select Yes if the problem occurred due to wrong usage. Otherwise, select No. |
| Recommended Actions | Explain the actions recommended. |
| Summary Details | Type the summary of the evaluation. |
| Evaluator | Type the name of the external evaluator, if any. |
| CAPA Number | Type the CAPA number. |
| Corrective Action Target Date | Click and select the target date to implement the identified actions. |
| Initial Corrective Actions | Type corrective actions as recommended by the manufacturer |
| Preliminary Analysis | Type comments from preliminary analysis performed by the manufacturer |
| Device Analysis Results | Type results of device analysis performed by the manufacturer |
| Additional Information | Type additional information from the evaluation |