Parker, Waichman, Alonso LLP

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Date of bypass surgery:

Is the device still implanted?
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What medical condition prompted the use of the device?

Do you know that the St. Jude Symmetry Aortic Connector was used in your surgery?
Yes
No

Did the Symmetry Connector cause any of the following?
Death
Heart Attack
Respiratory Failure
Valve Leakage
Additional Surgery
Other

Please describe any problems or injuries caused by the device:

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