Please select one of the following:
Only 1 instrument per request, if you have more than one please add another request
The date the event took place
The date when you were made aware that the event had occurred.
This can be the same or different from the Date of Event
Was this identified during, prior or after medical procedure/installation/in coming inspection/service, out of box failure?
What was experienced? What happened?
Any unanticipated medical procedures/treatments/therapy administered in relation to the alleged event or device malfunction.
Any unanticipated delay or prolongation to any medical procedures/treatments/therapy?
i.e. images, pictures, x-rays, scans, videos or any other supporting documentation.
If yes, Keeler Ltd will contact you to co-ordinate the product return
• Important! Keeler cannot be held responsible for equipment that is damaged or lost in shipping. Therefore, we strongly advise that you follow these instructions carefully.