Customer Feedback / Incident Report
Date of Incident
Quantity of Failed Units
Surgeon(s) name(s) and Contact Details
Was there a patient injury?
If yes, what is the status of the patient now?
Was there a delay in procedure?
If Yes, how long was the procedure delayed?
Less than 30 Minutes
30 Minutes to 1 Hour
More than 1 Hour
How did they complete the procedure?
(i.e. another Genicon Unit or a competitor's product)
Was this a single use device that had been reprocessed?
Is the product available for return to Genicon? If yes, we will provide our shipping account.
FM-SOP-16-8.2.2-01-F2 Rev. AD
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