Potential Recall Initiation Form

Complete this Potential Recall Initiation Form if you are an external party that needs to notify the PPD clinical research business of Thermo Fisher Scientific that your product/material is being recalled which could affect us. This form will notify the appropriate personnel to address the recall as appropriate. Thank you.

Please enter ‘not applicable’ or ‘N/A’ if the information is not relevant or unknown in the required fields.
Date of This Notification*
MM slash DD slash YYYY

mm/dd/yy
Effective Date Product/Material was Recalled*
MM slash DD slash YYYY

mm/dd/yyyy
Submitter's Name*
First Last
Submitter's Email Address*
Submitter's Job Title*
Company Name*
Description of Recall – including any background info the vendor/3rd party company may provide (provide as much information as possible in this section)*
Vendor/3rd party Company Name – Manufacturer/Provider of recalled item(s)*
Name of Product/Material being Recalled*
Enter Region/Country where the product/material was recalled (if known)*
Batch numbers/Lot numbers affected and Quantity*
Additional Information*
PLEASE ATTACH RECALL NOTIFICATION AND ANY ASSOCIATED DOCUMENTATION*
Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 4.
Uploaded files should be in PDF format
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