Skip to main content

< Back to Search Result
Share X Facebook Copy Link
Incident Report Details
Attachments (0)
Report Summary

Product Details
  • Product Description:
  • Manufacturer/Importer/Private Labeler Name:
  • Brand Name:
  • Model Name or Number:
  • Serial Number:
  • UPC Code:
  • SKU#:
  • Date Manufactured:
  • Retailer:
  • Retailer State:
  • Purchase Date:
  • Product Category: Clothing (Children)
  • Product Type:
  • Product Code:
Associated Recall
Incident Details
  • Incident Description:
  • Incident Date:
  • Incident Location:
Victims Involved
  • Injury Information:
  • My Relationship to the Victim:
  • Sex:
  • Victim's Age When Incident Occurred:
Comments from the Manufacturer/Private Labeler
Additional Details
  • Submitter has product?:
  • Product was damaged before incident?:
  • Product was modified before incident?:
  • If yes to any, explanation:
  • Have you contacted the manufacturer?:
  • If Not, Do you plan to?:
  • Report Number:
  • Report Date:
  • Sent to Manufacturer/Importer/Private Labeler:
  • Report First Publication Date: 5/31/2001
  • Category of Submitter: