Claim

ANGIOLINE constantly carries out activities to improve quality and reliability of the manufactured products. In case of any events related to the use of our products, please provide full details in this form and send it to us. Use one form per each event. Standard period for consideration of the submitted event information is one month of the date of receipt of the device and all the required data as provided below.



Medical institution details



Data on medical devices

Denomination Code number Lot (batch) number* Quantity Sent for analysis (if YES, tick off)

* This is the required field.



For the analysis to be performed, the following records have been sent:
(if YES, tick off)


Video of angiography
Surgery protocol


The form is submitted

For information purposes
Response is required

Description of the event (this is the required field, unless the surgery protocol is submitted)
Please indicate the date and provide a description of the event and its consequences.