Product Reference Code code
Product Lot code
When has the event occurred *: Before, during or after use of the device?
What were the consequences for the patient due to the adverse event?
What has been done by the end user (i.e. Doctor, nurse, etc) to solve the the problem?
Patient information (the case): gender, age, known medical history & clinical condition
Envio de arquivo
Click or drag a file to this area to upload.
Send photos or videos of the product
Comentário ou Mensagem