Tobacco Product Events or Malfunctions - TIG


This is an example CRF used to collect events and malfunctions associated with the operation of the tobacco product device.



"Tobacco Implementation Guide -Tobacco Device Product Events or Malfunctions [TIG_PROD_DEV_EVT_MAL]" Form Preview
Tobacco Implementation Guide -Tobacco Device Product Events or Malfunctions
Any Product Device Events or Malfunctions
Were any tobacco product events or malfunctions experienced? No  Yes  
What was the tobacco product identifier?
Product Device Events or Malfunctions
What was the event associated with this device?
Start Date
 01 Jan 2000
What was the pattern of the event? Single Event  Intermittent  Continuous  
What action was taken with the device?
What was the identifier for the primary adverse experiene(s) associated with or related to this device event?
What was the identifier for the primary adverse experienc(s) associated with or related to this device event?
* Mandatory field