CXL-365 vario
corneal cross-linking
1025_IFU_507536 CXL-365 vario_EN_Rev 09
Page 47 of 49
6.7.3
Information on incidents occurring after marketing
According to 93/42/EWG article 10 all incidents with medical devices have to be reported. Any
occurrence, problem or change in performance or output, which causes death or injury at the patient
hast to be reported.
Date: _________________
Serial number of device: _____________________________
Occurrence; failure description, potential hazard:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Clinic: ______________________________________________________________________
Reported through name / signature: _____________________________________
Send to:
MLase AG
Industriestr. 17
82110 Germering
Germany
Tel.: +49 89 8941850 0
Fax.: +49 89 8941850 10
Please use a copy!