Name Email Aware Date Device - Select -1000-00-101 KINCISE Impactor1002-00-102 KINCISE Battery Pack1003-00-102 KINCISE battery charger1010-01-101 Kincise Posterior Broach Adaptor1010-01-102 Kincise Anterior Broach Adaptor1011-01-101 Kincise Pinnacle shell impactor1012-01-101 Kincise Bullet tip stem inserter103-00-101 Kincise femoral head impactor2000-15-005 - Kincise Emphasys adapter Is battery at end of life? Yes No How many batteries? Facility Name Serial Number Event Date When did it occur? Pre SurgerySurgeryPost SurgeryCleaningTestingOther Injuries YesNoUnknown Delays YesNoUnknown Problem with device Territory State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorthern Mariana IslandsNorth CarolinaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Territories - Select -228-DC MEDCL LLC ATL230-DPY JT 230 INSTRMNT ORDRS Territories - Select -A1A INC Territories - Select -255 -LEGACY CONSULTANTS ARIZONA Territories - Select -207-DPY JT 207 INSTRMNT ORDRS213-TITAN ORTHO SALES LLC-DALLAS Territories - Select -135-DPY JR T135 HAWAII- HAWAII218-GOLDEN STATE ORTHOPDCS CM- CM238-GOLDEN ST ORTHOPDCS SAC241-GOLDEN STATE ORTHOPEDICS-LA Territories - Select -226-DPY JT 226 INSTRMNT ORDRS Territories - Select -133-DPY JR T133 NEW- NEW YORK EAST TEAM202-DPY JT 202 INSTRMNT ORDRS Territories - Select -141-DPY JT 141 INSTRMNT ORDRS252 - HALL & ASSOCIATES INC Territories - Select -228-DC MEDCL LLC ATL230-DPY JT 230 INSTRMNT ORDRS Territories - Select -228-DC MEDCL LLC ATL Territories - Select -135-DPY JR T135 HAWAII- HAWAII Territories - Select -135-DPY JR T135 HAWAII- HAWAII Territories - Select -210 - RARIDON & ASSOC ORTHOPEDICSA1A INC Territories - Select -210 - RARIDON & ASSOC ORTHOPEDICS Territories - Select -139 - DPY JT 139 INSTRMNT ORDRS253 - IN MOTION ORTHOPAEDICS INC.254 - DPY JT 254 INSTRMNT ORDRS Territories - Select -234-DPY JT 234 INSTRMNT ORDRS-SPRING Territories - Select -253- IN MOTION ORTHOPAEDICS INC. Territories - Select -230-DPY JT 230 INSTRMNT ORDRS234-DPY JT 234 INSTRMNT ORDRS-SPRING Territories - Select -207-DPY JT 207 INSTRMNT ORDRS Territories - Select -250 - DJD MEDICAL INC Territories - Select -128-DPY JT 128 INSTRMNT ORDRS133-DPY JR T133 NEW- NEW YORK EAST TEAM141-DPY JT 141 INSTRMNT ORDRS203-DPY JT 203 INSTRMNT ORDRS253- IN MOTION ORTHOPAEDICS INC.218-GOLDEN STATE ORTHOPDCS CM- CM226-DPY JT 226 INSTRMNT ORDRS250 - DJD MEDICAL INC Territories - Select -202-DPY JT 202 INSTRMNT ORDRS250 - DJD MEDICAL INC Territories - Select -229-IN MOTION ORTHO MICHIGAN Territories - Select -212-DPY JT 212 INSTRMNT ORDRS Territories - Select -230-DPY JT 230 INSTRMNT ORDRS Territories - Select -253- IN MOTION ORTHOPAEDICS INC. Territories - Select -238-GOLDEN ST ORTHOPDCS SAC Territories - Select -210 - RARIDON & ASSOC ORTHOPEDICS253- IN MOTION ORTHOPAEDICS INC.226-DPY JT 226 INSTRMNT ORDRS Territories - Select -202-DPY JT 202 INSTRMNT ORDRS250 - DJD MEDICAL INC Territories - Select -134-DEPUY JOI- NEW JERSEY DEPUY SYNTHES203-DPY JT 203 INSTRMNT ORDRS252 - HALL & ASSOCIATES INC Territories - Select -226-DPY JT 226 INSTRMNT ORDRS Territories - Select -133-DPY JR T133 NEW- NEW YORK EAST TEAM146-DPY JT 3146 INSTRMNT ORDRS233-DPY JT 233 INSTRMNT ORDRS250 - DJD MEDICAL INC Territories - Select -239-DPY JT 239 INSTRMNT ORDRS Territories - Select -135-DPY JR T135 HAWAII- HAWAII Territories - Select -211 - ORTHOMIDWEST234-DPY JT 234 INSTRMNT ORDRS-SPRING Territories - Select -213-TITAN ORTHO SALES LLC-DALLAS Territories - Select -A1A INC Territories - Select -134-DEPUY JOI- NEW JERSEY DEPUY SYNTHES203-DPY JT 203 INSTRMNT ORDRS233-DPY JT 233 INSTRMNT ORDRS252 - HALL & ASSOCIATES INC Territories - Select -202-DPY JT 202 INSTRMNT ORDRS Territories - Select -239-DPY JT 239 INSTRMNT ORDRS Territories - Select -253- IN MOTION ORTHOPAEDICS INC. Territories - Select -228-DC MEDCL LLC ATL230-DPY JT 230 INSTRMNT ORDRS Territories - Select -207-DPY JT 207 INSTRMNT ORDRS213-TITAN ORTHO SALES LLC-DALLAS226-DPY JT 226 INSTRMNT ORDRS Territories - Select -A1A INC Territories - Select -250 - DJD MEDICAL INC Territories - Select -128-DPY JT 128 INSTRMNT ORDRS132-DPY JT 132 INSTRUME136-DPY JT 136 INSTRM-INSTRUMENT ORDERS Territories - Select -A1A INC Territories - Select -132-DPY JT 132 INSTRUME Territories - Select -DPY JT 225 INSTRMNT ORDRS Territories - Select -226-DPY JT 226 INSTRMNT ORDRS Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Shipping Info UCN Name Address Address Address 2 City/Town State/Province ZIP/Postal Code Submit Leave this field blank