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Versajet Complaints Form

Welcome to the New Zealand Smith & Nephew Versajet complaints registry.

Please fill out all areas of the form and click on the submit button at the end.

Was Patient Involved?
Was this an Out-Of-Box failure?
Was the problem noted before, during or after the procedure?


Was the patient anethetised at the time?
Did the problem result in a patient injury/ harm/ hazard?
Was a backup device available?



Did any pieces break off inside the wound?



Was the piece removed?
Will the device or a sample be returned for evaluation?



Is the device under warranty?
Are there any supporting images, surgical reports etc? If yes, please send all to the RA/QA coordinator
Please select which Versajet item the issue was recorded




Please identify when the error occurred and complete the fields for the relevant heading:
During Biomed Check-In: Did the console power on?
During Biomed Check-In: Did the console pass all biomed system check requirements?
During Set-Up: Did the console power on?
During Set-Up: Did problems occur while connecting the handpiece?

If yes, please check one:


During Set-Up: Did the handpiece prime?
During The Procedure: The handpiece was used (Intermittently OR continuously) before the error/malfunction occurred

During The Procedure: Did the console display a Fault/Error Code

During The Procedure: If yes, please check one:



During The Procedure: Were there issues with the foot pedal during use?
During The Procedure: Were there issues with the handpiece during use
During Procedure: If yes, please check all that apply







During Procedure: Were there any excessive leakage
During Procedure: Was the leakage saline?

During Tear Down: Did any problems occur while disconnecting the hand-piece key?

During Tear Down: If yes, please check one:

Gender