Report a Complaint and/or Adverse Event (Incident)

If you experience a problem with our medical device or wish to report a product complaint, please contact our team as soon as possible.

Email: info[at]synergo-medical.com or pms[at]synergo-medical.com or contact us by phone: +31 20 6423719 or +972 3 9244830

Our team will acknowledge your report and may contact you for additional information to support our investigation.

By contacting our team, you acknowledge that your email may be retained for quality assurance purposes. We may collect and process your personal information to respond to your inquiry, comply with legal obligations (including product safety requirements), investigate reported issues, and improve our products. Your information may be shared with regulatory authorities and affiliated entities, including those in the United States, where different data protection standards may apply.

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Reporter Information

• Reporter’s Name (First and Last Name):

• Reporter’s Email Contact:

• Reporter’s Telephone Contact:

• Facility Name (Where the incident occurred):

• Facility Address (Street, City, Province, Postal Code):

 

Product Details

• Product Name:

• Catalog Number:

• Lot number:

 

Event Description

• Date of Incident (MM/DD/YYYY):

• Description of Event (Give specific details of event):

• Was there any alleged Injury or Harm to User or Patient? (Give detailed information):

 

Additional key information

• Death involved yes/no, serious injury, safety issue, other type of actions taken.