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Step 1
About You
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Step 2
About the Incident
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Step 3
Affected Person
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Step 4
About the Device
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Step 5
Finish and Submit
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| Please provide your name and at least one contact method |
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| What is the preferred contact method? |
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| Please confirm your contact and privacy instructions |
| Are you happy for the device company to know your identity, and for your contact information to be provided to the device company so that they can contact you about this incident?*
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| Who should the TGA contact for more information regarding this incident? |
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| Are you reporting this incident on behalf of someone else (the initial reporter)? |
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