Product Experience

Your experience is important

We want to ensure the best quality of care for patients, which means we continually strive to produce the best products and services based on physician and patient experience. Help us improve our products and services by sharing your experiences with us today.

To read our complete Privacy Notice that details our nine privacy principles that protect your personal information, click here.

Please create a separate report for each device related to this event.

Any fields left blank may result in a follow-up email and/or phone call from Product Surveillance.

* Required field

Your Role

What date did you become aware of the event?

If you selected "other" from the “Your Role” options please describe your role.

Describe your role

First Name

Last Name

Email Address

Phone

Patient First Name

Patient Last Name

Patient Name Unavailable/Withheld for Privacy Reasons (Outside the U.S.) Unavailable/Withheld

Provide reason patient name is unavailable or Patient Reference Number (Outside the U.S)

Patient Date-of-Birth

Check if Unavailable/Withheld Unavailable/Withheld

Provide event description including patients presenting symptoms and intervention

Has a surgery taken place

If no, is a future revision planned?

Surgery/Procedure Date

Check if Unavailable/Withheld Unavailable/Withheld

Describe intervention (which, if any, components were removed, and date of surgery/intervention)

Patient Status Following Intervention* (e.x. no further complications, additional complications of...)

Device Name associated with this event

Lot/Serial # of components related to the reported issue

Check if unknown Unavailable

Is the product being returned to us? Yes No Unknown

If in the U.S., do you need an RGA for the return? Yes No

Physicians First Name

Physicians Last Name

Account Number

Street Address 1

Street Address 2

City

Zip Code

Country

State

Physician Phone Number

Upload

Can we contact you if additional information is needed? Yes No

My account

Product Experience

Your experience is important