MEDICINES CONTROL AGENCY 54 Kairaba Avenue, Pipeline, The Gambia. Tel.No. +220 4380632, www.mca.gm RECALL REPORT FORM Details of the recalled products Name of the product MCA Registration number Active ingredients & strength Dosage form Pack size Batch number Expiry date Reasons for recall Extent of Distribution Imported/ manufactured quantity Quantity exported Countries of Export Quantity distributed: No. of Consignee Action taken by the Reporter Result of Recall Quantity of stock returned Quantity of stock outstanding Quantity of stock used or sold by the consignees Quantity of stock not located No. of Replies received from consignees on all stock returned/ reported Disposal Plan Method of Disposal □ Destroy □ Return to manufacturer □ Others, please specify: Details of the disposal method Name of Reporter: Contact no. (mobile): Signature of Reporter: Date: MCA-F-303/02, version 2, 01 July 2020 Page 1 of 1
