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Medical facility data
Patient gender
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Medical device data
Number
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+
* Without specifying the lot number, consideration of the complaint is impossible.
Submitted for analysis (check if directed)
For the analysis, records were sent: (check the appropriate box, if directed)
Angiography recording
Operation protocol
The complaint is sent
For informational purposes
For informational purposes
Description of the event (mandatory, if the operation protocol is not provided)
I agree to the transfer and
processing of personal data
*
Send
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Reclamation
