Customer Survey- Structo® Nasopharyngeal Swab
Answers marked with a * are required.
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Organization Name. *
1) Please check all the patient categories that the product has been used on. Mark all that applies. *

2a) Please evaluate the level of acceptability of each of these features. *
  5 (Most Acceptable) 4 3 2 1 (Most Unacceptable)
Instructions for Use (IFU) are sufficiently clear
Ease of opening of pouch
Device is flexible to navigate the nasopharyngeal canal during insertion
Device is flexible to remove from the nasopharyngeal canal after specimen collection
Device reacts sufficiently to rotation for specimen collection
Snapping of the swab at breakpoint post-specimen collection
Surface finish of the swab (If 1 or 2 is selected, comment in section 2d)
2b) Were any of the following situations encountered?  *
  Yes No
Information/ Items were missing from the product (eg. IFU, expiration date). If yes, please indicate what was missing in section 2d:
Sterile pouch or primary box was compromised before use
Swab breakage in an unopened sterile pouch on removal from the box
Products were expired on delivery
Swab breakage in patient during specimen collection
Insufficient specimen collected by swab
Dripping of specimen from swab head after retrieval (poor fluid retention)
Swab was not compatible with UTM/ VTM. If yes, please indicate the UTM used in section 2d:
Adverse reaction of a particular patient during use of the swab
2c) Were there situation or patient profiles in which the swab could not be successfully used? If yes, please describe.
2d) Additional Information for 2a) surface finish of swab, 2b) missing information/ items from product and non-compatible UTM/ VTM used.
Surface finish of swab (too rough/ too smooth):
Missing information/ items from product:
Non-compatible UTM/VTM used:
3) Additional feedback.
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