Please do not disclose any private or personally identifiable information about yourself or others as part of this activity.
Name of device
Date of Birth
Date of Death
Value at Death
Provide a sketch of the deceased device at the time of death, including any visible marks of damage, if applicable. It may be easiest to make a sketch on paper, take a photo, and upload it here
Drag here to upload or click here to browse
2 MB file size maximum. Allowed file types png, jpg.
Probable cause of death
What was the likeliest cause of death (to be listed on the death certificate)
Timeline and treatment history
Provide a bulleted summary of the device’s end of life trajectory, backwards from death, and highlighting any major health incidents and treatment measures that may be relevant in the device’s death
Describe any other conditions or circumstances that may have contributed to the death
Identify any learnings from this incident that may inform future behavior