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Updated September 16, 2021

Template: Periodic Safety Update Report

Sven Piechottka
ISO 13485

This is a free template, provided by OpenRegulatory.

A preview of the template is shown below. You can download it as Word (.docx), PDF or markdown file.

The template license applies (don't remove the copyright at the bottom).

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Beginning of template

Periodic Safety Update Report

This report describes product-specific post-market surveillance activity output as outlined in the Post-Market Surveillance Plan.


Product Name:  
Unique Device Identification (UDI):  
Surveillance Period:  

1. Summary

Note: Highlight which issues around safety and performance of your device you identified.

2. Impact on Clinical Evaluation: Benefit and Performance

Are the claims made for expected benefits and performance being met?

( ) Yes ( ) No

If not, reasons for deviation:

3. Impact on Risk Management: Risks and Benefits Determination

The medical device is safe and the risks correspond to the assumptions in the risk management file:

( ) Yes ( ) No

If not, describe new risks that have been identified:

Do the clinical benefits of the device outweight the risks?

( ) Yes ( ) No

If not, reasons for deviation:

4. Results of Post-Market Surveillance Activities

Summary of Incidents and Problems

Describe incidents that happened with your device and actions taken (e.g. adverse event reports to authorities, field safety notices to customers, field safety actions).

Observed undesirable side effects

Describe incidents that happened with your device and actions taken.

Title Date Hazard in Risk Table Expected Frequency / Severity Assessment

List of CAPAs

The following CAPAs resulted from post-market surveillance activities during product lifetime and the following CAPAs were initiated during this surveillance period:

Summary of Customer Complaints and Problems

Overall Feedback Assessment:

(enter content)

Note: Summarize the number of customer complaints, predominant subjects of feedback and whether there was anything of importance regarding safety. More specifically, take into account:

  • Is the overall complaint rate deemed acceptable and if so, why?
  • Based on feedback, have any trends been analyzed and have any corrective measures been taken? What is the status of such actions?
  • Has PMS data been compared to occurrence probabilities from risk management?

Copy this table for every relevant feedback issue that you have analyzed

Feedback Source  
Root Cause  

SOUP Issues

Describe anything of relevance you found when going through issue trackers of your SOUP. Also describe whether this lead to any changes, e.g. you could have updated the SOUP to a newer version (and then updated that entry in the SOUP list), or you identified new risks which should be added to the risk table.

The SOUP List has been updated.

(Describe significant changes, e.g. new risks, if applicable)

Post-Market Data of Similar Products

Note: copy the sections below for every database that you looked into.

BfArM Database(s)

Short description of database:

Search keywords: (Insert keywords)

Subject Description and Date Assessment Applicable (Yes / No)

FDA Database(s)

Short description of database:

Search keywords: (Insert keywords)

Subject Description and Date Assessment Applicable (Yes / No)

Summary of Post-Market Clinical Follow-Up Findings

Main Findings of Post-Market Clinical Follow-Up Activities:

Describe the main findings that were derived from your post-market clinical follow-up.

Status of Post-Market Clinical Follow-Up Activities:

Describe or list here which PMCF activities are planned, were adjusted or completed. Include evidence that the post-market surveillance activities are meeting their objectives. Reference the location of the original data and the analysis performed.

State of Research and Development

Market Information on Similar Devices

Note: Describe any relevant information on similar devices in the market, e.g. clinical studies that started with outcomes that may be applicable to our device.

Copy this table for every issue that you evaluated.

Results (incl. date)  

Scientific Literature

Note: This chapter should analyze other publications applicable to our product if not considered already as part of the post-market clinical follow-up.

Copy this section for every issue that you evaluated.

Short description of database: Search keywords: (Insert keywords)

ID / Title Description (incl. date) Assessment Applicable (Yes / No)

General Updates of Standards and Legislation

List legislation and standards which were updated in the meantime. E.g. there could be a new version of ISO 13485 which could be relevant for your company.

5. Trend Analysis

Describe trends that you identified according to the metrics and threshold values that were specified in your post-market surveillance plan.

For example: during the surveillance period, we received several customer complaints related to product feature XYZ. Malfunctioning of this software component led to XYZ cases of minor injury which was not anticipated. Therefore, we initiated action to do XYZ (ideally, refer here to the listed CAPAs in section 1 above).

Copy this table for every issue that you evaluated.

Date / Time Span  
Occurrence acc. to  
Probability acc. to risk table  
Assesment and Actions Taken  

Updated Post-Market Surveillance Plan

List updates to Post-Market Surveillance Plan, if applicable

Template Copyright See template license.

Please don’t remove this notice even if you’ve modified contents of this template.

End of template


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