* First Name 

   * Last Name 

   * Email 

   * Phone 

Cell Phone 

Date the device was implanted:

Do you know that the PRECISE RX Stent was used in your surgery?Yes
No

Is the device still implanted?Yes
No

What medical condition prompted the use of the device?

Did the Stent cause any of the following?Coma
Seizure
Stroke
Death
Other

Please describe any problems or injuries caused by the product:

No Yes, I agree to the Parker Waichman LLP disclaimers. Click here to review.

Yes, I would like to receive the Parker Waichman LLP monthly newsletter, InjuryAlert.