chipmenot-reportacase

Use the below form to a report an adverse reaction to a microchip implant:

If you have not reported your pet's adverse microchip reaction to the manufacturer/distributor of the microchip and to the official adverse reporting agency in your country, we strongly urge you to report it to them.

First Name
Middle Name
Last Name
Address
Phone number(s)
E-mail:
Can we share your story with our readers?	Yes No
Can we please contact you if we need additional information?	Yes No
ANIMAL INFORMATION
Animal Type	Dog Cat Horse Other :
Gender	Male Female
Neutered / spayed ?	Neutered Spayed Neither
Size of animal	Small Medium Large
Approximate weight
Name of animal
Animal date of birth
Current age
MICROCHIP INFORMATION
Microchip number
Distributor/Manufacturer of microchip
Date of implantation
Original site of implant
Current site of implant
Date of reaction
ADVERSE REACTION Check all that applies:
	Pain Swelling Infection Abscess Bleeding Tumor Migration Neurological damage Sudden death due to implant procedure Unable to read implant (reason):
Other reaction (please describe)
VETERINARIAN INFORMATION:
Name of veterinarian who treated your animal
Name of veterinary clinic
Address
Phone number(s)
Email
Website
CAN YOU PROVIDE A COPY OF THE FOLLOWING INFORMATION?
	Veterinary report Biopsy report Pathology report X-Rays Photographs Published scientific report regarding your pet's case
Other supporting documentation regarding your pet's adverse reaction that you can supply
NARRATIVE
We would appreciate it if you would share your pet's adverse reaction in detail with the readers of our website so that they are able to make an informed decision regarding microchip implants for their animals. If you prefer not to share your story, we will use your information for an aggregate data report only, where you and your animal could not be identified.

PICTURE Please attach a photo of your pet if you would like it to be posted with your story. File to upload: