Report a complaint

Report a device malfunction or adverse event. We will register it and reply within the required time.

1Medical institution

Medical institution

Contact person

Physician's name

Phone

E-mail

2Device

Device

Reference (REF)

Lot number (LOT) A complaint cannot be processed without the lot number.

Quantity

3Patient — no names

Patient sex

Patient age, years

4Event

Device sent for analysis Angiography recording Operation protocol For information only Reply required

Event description Date, detailed description and consequences. Required if no operation protocol is attached. Do not include the patient's name or other personal data.

I agree to the transfer and processing of personal data