PLEASE PROVIDE YOUR NAME AND AT LEAST ONE CONTACT METHOD
PLEASE CONFIRM YOUR CONTACT AND PRIVACY INSTRUCTIONS
WHAT WENT WRONG?
WHERE DID THE INCIDENT OCCUR?
HAS THE SUPPLIER BEEN TOLD ABOUT THE PROBLEM?
Please note that you don't have to fill in these fields below if you don't have the information or would rather not report it.
DESCRIBE THE HEALTH CONSEQUENCES
Try to provide as much information as possible to help identify the device, including additional details such as model, version etc. if relevant and available. Ensure that the device is quarantined with all consumables and packaging.