Ultherapy form

Ultherapy form

formular for at registrere Ultherapy events/issues

Ultherapy Form - Appendix A-Field Experience Report

Device in use 

Description of Event/Issue

Product issue
Patient-related issue
Serious public health threat or death must be reported immediately. Has a serious public health threat or death occurred?

Actions

Was a replacement or loaner provided?

PHYSICIAN/CLINIC/INSTITUTION

Follow up report is requested

FORM COMPLETED BY

Has the event been reported to the local regulatory body?
Has the event been reported to the local regulatory body?

Attach support log file

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