Merz Technical Complaint

Merz Technical Complaint

DISTRIBUTION PARTNER DETAILS

CUSTOMER DETAILS - Physician/ Physician’s Office Hospital Pharmacy Other, specify:

PRODUCT

Product available?
Product attached?
Product already requested?
Product already replaced?

REASON FOR COMPLAINT

Størst tilladte upload: 268MB
Was this Technical Complaint associated with an adverse event?
*Note: Adverse Reactions/ Side effects to be documented on a seperate form
Needle Type
For Xeomin/ Bocouture: Reconstitution needle size (Recomended: 20-27G)