System information

Regulatory Notices
E-4 Vicon MX Hardware System Reference
Section C. Description of Event or Problem
Parameter Date
Date of Event MM/DD/YYYY
Date of report by initial reporter MM/DD/YYYY
Description of event or problem, including a
discussion of how the device was involved, nature
of the problem, patient follow-up or required
treatment and any environmental conditions that
may have influenced the event
Description of relevant tests including dates and
laboratory data
Description of the relevant history including
pre-existing medical conditions
MXhardware_Reference.book Page 4 Thursday, September 7, 2006 11:36 AM