Notification of unexpected adverse incident

In case of complications we kindly ask you to complete and submit this form.

Treatment type

Tick what is applicable:
Was there an electrosurgical pad connected?
If YES, what type of pad did you use?
What other devices are connected to the patient at the time of complications?

Is/are there any other devices connected to sockets near the RF generator? (in the same distribution or nearby sockets)
PLEASE ATTACH VISUALS: Images of the immediate and/or delayed complication, picture of the RF-generator screen, …
Drop files here or
Max. file size: 256 MB.