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System Misdetects Wash 1 Fluid
This response form is to confirm receipt of the enclosed Siemens Healthcare Diagnostics
Urgent Field Safety Notice dated November 2012 regarding System Misinterprets Wash 1 Fluid
Signals 10813924. Please read each question and indicate the appropriate answer. Fax this
completed form to Siemens Healthcare Diagnostics at the fax number indicated at the bottom of
this page.
I have read and understood the Urgent Field Safety Notice instructions
provided in the November 2012 letter.
Name of person completing questionnaire:
Title:
Institution:
Street:
City:
PLEASE FAX THIS COMPLETED FORM TO THE TECHNICAL SOLUTIONS CENTER AT
(###) ###-####
Siemens Healthcare Diagnostics
Siemens Healthcare Diagnostics
GPF-003 -11 V1.0 Effective: September 21, 2012
Related Procedure: GP-003 DX- Field Correction Action
FIELD CORRECTION EFFECTIVENESS CHECK
System Misinterprets Wash 1 Fluid Signals
State:
511 Benedict Ave.
Tarrytown, NY 10591
All rights reserved.
Yes
Instrument Serial Number:
Phone:
www.siemens.com/diagnostics
No
Page 5 of 5
10813924, Rev. A
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