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Nome
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E-mail
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Telefone
Product Reference Code code
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Product Lot code
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When has the event occurred *: Before, during or after use of the device?
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What were the consequences for the patient due to the adverse event?
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What has been done by the end user (i.e. Doctor, nurse, etc) to solve the the problem?
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Patient information (the case): gender, age, known medical history & clinical condition
*
Envio de arquivo
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Comentário ou Mensagem
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