Product Complaint & Adverse Event Reporting

Please complete this form in its entirety.
By completing this form, you grant Movora permission to consult at will all information provided below and to contact you for processing of your request.
Please complete all required in order for Movora to adequately assess the situation. If any information is not applicable or unknown, please indicate so. No fields may be left blank.
If this is an emergency, please contact your regional representative. You can find their contact information using this link.
Cases that require technical external review may take up to 10 business days to resolve.
By submitting this form, you are confirming that you have read and agree to Movora's Privacy Policy.

Surgeon Contact Details

First Name: *

Last Name: *

Email: *

Phone: *

Practice Information

Practice Name: *

Customer Account Number:

Country: *

What kind of issue would you like to report? *

State/Region: *

step 2a

Date of Incident: *

Invoice/Order Number: *

If not available at this time, please type "not available." Resolution of your problem may require this number at a later time.

Please Describe the Nature of the Problem in Detail: *

Please attach any applicable information which may be helpful:

step 2b Operating Surgeon's Name: *

Movora Representative Name: *

With what brand of product did the issue occur? *

Surgery Type: *

Please describe the nature of issue in detail: *

If available, please provide the product part number or a detailed description of the part including size: *

If available, please indicate the product lot number:

Was there an Adverse Patient Event or other surgical complication?*

Yes No

step 3a Date of Incident: *

Please indicate what other instruments were in use at the time the issue occurred: *

Please attach any applicable information which may be helpful:

Return of the defective product is required for our investigation of the issue. Once returned, Movora will determine if the issue can be repaired or replaced/refunded. Please contact your sales representative for shipping details. To ensure safety, contaminated product shall be sterilized and identified as STERILE. Please complete the sterilization certificate provided with the return label and package with the returned product prior to shipment. *

I acknowledge and allow the information and images I provided as part of this report, or in association with this report, to be reviewed by internal Movora employees as well as external advisers. Case and images will not be used for any other purposes unless agreed upon through written documentation. I confirm that I am authorized to enter and submit for review the data entered in this form. I acknowledge and agree to Movora's Privacy Policy. *

step 3b p1

Date of original surgery: *

Date of complication: *

Patient Weight (kg) at the time of orignal surgery: *

Patient Weight (kg) at the time of the incident: *

Patient Breed: *

Patient Age: *

Please describe the patient's activity level

Was the patient hospitalized overnight or sent home the same day after the initial surgery?

Are you requesting a consultation through Movora for the revision? *

Yes No

Did the patient present with any other comorbidities? *

Yes No

Please describe any comorbidities present.

Do you feel the patient-owner(s) maintained post-op compliance? *

Yes No Maybe

In what way might the patient-owner(s) not have maintained post-op compliance?

Has a revision been perfomed?*

Yes No

Please describe revision surgery in detail.

Date of Last Follow-Up:

Please upload Planning radiographs here:

Without X-Rays certain complaints cannot be assessed. (THR, PGR, fracture, TPLO) Please upload Pre-op radiographs here:

Please upload Post-op radiographs here:

Please upload Follow-up radiographs if available

Please state the size(mm) of the radiograph calibration used. *

Did the issue occur with an implant or instrument? *

step 4a

Please indicate what other implants were used and their size (if any).*

Was the implant modified (including contouring)? *

Yes No

Please describe how the implant was modified.

Were any of the implants used not distributed through Movora? *

Yes No

Please describe:

Was Preoperative Planning performed? *

Yes No

Please provide a complete summary of the case, including any modifications to the surgical technique, as well as the treatment plan.

Alternatively, a case summary may be uploaded here.

Are you able to provide release instructions with a signature from the pet-owner?

Yes No

Please attach the release instructions here.

Return of the defective implant is typically required for a full investigation of the issue. Once returned, Movora will determine if the issue can be repaired or replaced/refunded. Please contact your sales representative for shipping details.*

step 4b

Thank you for providing detailed information that helps us improve our devices and resolve product issues. If you have the following information available, please submit it at this time. If you do not yet have the information gathered, you can share it with your Movora team at a later date. Please note: Investigation will begin once all radiographs have been submitted.

Please indicate what other instruments were in use at the time the issue occurred: *

Please provide any relevant attachments (photos, radiographs, etc.):

Please provide a summary of the case and the issue noted, OR

Alternatively, a case summary may be uploaded here.

Return of the defective instrument is required for our investigation of the issue. Once returned, Movora will determine if the issue can be repaired or replaced/refunded. Please contact your sales representative for shipping details.

Product Complaint

and Adverse Event Reporting

Surgeon Contact Details

Practice Information