Vicon IX 2000 L Información técnica descargar pdf (Pagina 200)

Regulatory Notices

E-10 Vicon MX Hardware System Reference

Section D. Initial Reporter Information

For the reporter who initially provided information to you, or to the

manufacturer or distributor:

Operator of the device

(delete not applicable)

 health professional

 patient

 lay user

 other ____________________________

(specify)

Date of system installation

(mm/dd/yyyy)

Device available for

evaluation?

(Do not send to FDA)

 Yes

 No

 Returned to Vicon Motion Systems Limited

or its agents on: ___________

(mm/dd/yyyy)

Concomitant medical products and therapy dates

(Do not report products that were used to treat the event.)

Name

Address

Telephone Number

E-mail Address

Health Professional?

 Yes

 No

Occupation (include

speciality if appropriate)

Initial reporter also sent a

copy of report to FDA?

 Yes

 No

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