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Needles and Catheters Evaluation Form
CooperSurgical
2024-01-31T14:27:48+00:00
Step
1
of
24
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Hidden
Date of this evaluation submission
DD slash MM slash YYYY
Clinic Name
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Select Country
Afghanistan
Albania
Algeria
American Samoa
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Angola
Anguilla
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Antigua and Barbuda
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Account Number
Clinical Representative Name
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Please add more names if applicable
Embryology Representative Name
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Email of Contact Person
Product Details
Please select product
ONS1633 - WALLACE OOCYTE RECOVERY SET, 16G, 950MM ASPIRATION TECOFLEX TUBE, 10/CA
ONS1633-500 - WALLACE OOCYTE RECOVERY SET, 16G, WITH SHORTER 500MM ASPIRATION TECOFLEX TUBE, 10/CA
ONS1633-750 - WALLACE OOCYTE RECOVERY SET, 16G, WITH SHORTER 750MM ASPIRATION TECOFLEX TUBE, 10/CA
ONS1633LL - WALLACE OOCYTE RECOVERY SET OOCYTE RECOVERY SET, 16G, 950MM ASPIRATION TECOFLEX TUBE, FLUSHING CONNECTOR, 10/CA
ONS1633LL-500 - WALLACE OOCYTE RECOVERY SET OOCYTE RECOVERY SET, 16G, 500MM ASPIRATION TECOFLEX TUBE, FLUSHING CONNECTOR, 10/CA
ONS1633LL-750 - WALLACE OOCYTE RECOVERY SET OOCYTE RECOVERY SET, 16G, 750MM ASPIRATION TECOFLEX TUBE, FLUSHING CONNECTOR, 10/CA
ONS1733 - WALLACE OOCYTE RECOVERY SET, 17G, 950MM ASPIRATION TECOFLEX TUBE, 10/CA
ONS1733-500 - WALLACE OOCYTE RECOVERY SET, 17G, WITH SHORTER 500MM ASPIRATION TECOFLEX TUBE, 10/CA
ONS1733-750 - WALLACE OOCYTE RECOVERY SET, 17G, WITH SHORTER 750MM ASPIRATION TECOFLEX TUBE, 10/CA
ONS1733LL - WALLACE OOCYTE RECOVERY SET OOCYTE RECOVERY SET, 17G, 950MM ASPIRATION TECOFLEX TUBE, FLUSHING CONNECTOR, 10/CA
ONS1733LL-500 - WALLACE OOCYTE RECOVERY SET OOCYTE RECOVERY SET, 17G, 500MM ASPIRATION TECOFLEX TUBE, FLUSHING CONNECTOR, 10/CA
ONS1733LL-750 - WALLACE OOCYTE RECOVERY SET OOCYTE RECOVERY SET, 17G, 750MM ASPIRATION TECOFLEX TUBE, FLUSHING CONNECTOR, 10/CA
ONS1833 - WALLACE OOCYTE RECOVERY SET, 18G, 950MM ASPIRATION TECOFLEX TUBE, 10/CA
ONS1833-500 - WALLACE OOCYTE RECOVERY SET, 18G, WITH SHORTER 500MM ASPIRATION TECOFLEX TUBE, 10/CA
ONS1833-750 - WALLACE OOCYTE RECOVERY SET, 18G, WITH SHORTER 750MM ASPIRATION TECOFLEX TUBE, 10/CA
ONS1833LL - WALLACE OOCYTE RECOVERY SET OOCYTE RECOVERY SET, 18G, 950MM ASPIRATION TECOFLEX TUBE, FLUSHING CONNECTOR, 10/CA
ONS1833LL-750 - WALLACE OOCYTE RECOVERY SET OOCYTE RECOVERY SET, 18G, 500MM ASPIRATION TECOFLEX TUBE, FLUSHING CONNECTOR, 10/CA
ONS1833LL-500 - WALLACE OOCYTE RECOVERY SET OOCYTE RECOVERY SET, 18G, 750MM ASPIRATION TECOFLEX TUBE, FLUSHING CONNECTOR, 10/CA
DNS1633-500 - WALLACE DUAL LUMEN OOCYTE RECOVERY SET, 16G, 500MM ASPIRATION TECOFLEX TUBE, 10/CA
DNS1633-750 - WALLACE DUAL LUMEN OOCYTE RECOVERY SET, 16G, 750MM ASPIRATION TECOFLEX TUBE, 10/CA
DNS1633-950 - WALLACE DUAL LUMEN OOCYTE RECOVERY SET, 16G, 950MM ASPIRATION TECOFLEX TUBE, 10/CA
DNS1733-500 - WALLACE DUAL LUMEN OOCYTE RECOVERY SET, 17G, 500MM ASPIRATION TECOFLEX TUBE, 10/CA
DNS1733-750 - WALLACE DUAL LUMEN OOCYTE RECOVERY SET, 17G, 750MM ASPIRATION TECOFLEX TUBE, 10/CA
DNS1733-950 - WALLACE DUAL LUMEN OOCYTE RECOVERY SET, 17G, 950MM ASPIRATION TECOFLEX TUBE, 10/CA
Clinical Product Evaluation
Please provide your Vacuum Pump Brand Details?
What was the negative pump Pressure setting used in mmHg for each needle?
How easy was it to set up Wallace needle to your vacuum pump ?
Extremely easy
As easy as current brand
OK, but not as easy as current brand
Not easy
Unable to connect
Any additional comments regarding this question
How easy was it to insert and remove the test tube bung into and out of the test tubes during the procedure?
Extremely easy
As easy as current brand
OK, but not as easy as current brand
Not easy
Unable to connect
Any additional comments regarding this question
How easy was it to pretest the system and run a flow test prior to starting the procedure
Extremely easy
As easy as current brand
OK, but not as easy as current brand
Not easy
Unable to connect
Any additional comments regarding this question
How visible did you find the echotip marking of the needle under ultrasound?
Extremely visible better than other brands
Visible - same as other brand
Visible but preferred other brand
Poor visibility
Not visible at all
Any additional comments regarding this question
How easy (compared to current brand you use) was the needle to handle e.g. easy to hold, rotate within the ovary/follicle
Extremely easy
As easy as current brand
OK, but not as easy as current brand
Not easy, poor performance
Lowest satisfactory level
Any additional comments regarding this question
How easy did it feel to insert the needle into the ovary?
Extremely easy
As easy as current brand
OK, but not as easy as current brand
Not easy, poor performance
Lowest satisfactory level
Any additional comments regarding this question
How easy was it to access the follicles when entering the ovary?
Extremely easy
As easy as current brand
OK, but not as easy as current brand
Not easy, poor performance
Lowest satisfactory level
Any additional comments regarding this question
How easy was the flushing procedure (Only relevant if it was a Dual Lumen or Single Lumen LL code)
Extremely easy
As easy as current brand
OK, but not as easy as current brand
Not easy, poor performance
Lowest satisfactory level
Any additional comments regarding this question
How suitable was the aspiration tubing length and flexibility?
Perfect - just the right length and malleability
As good as current brand
OK, but preferred current brand
Not adequate performance
Lowest satisfactory level
Any additional comments regarding this question
How noticeable was bleeding during the procedure?
Minimal bleeding, good patient outcome
No more than I would usually experience
Slightly more than I would usually experience
Lots more than I would normally experience
Too much, patient needed surgery afterwards
Any additional comments regarding this question
On the overall performance of the needle, how satisfied were you with the Wallace needle for this patient
Extremely satisfied, better than current brand
Good performance as good as current brand
OK but prefer current brand feel
Not as easy to use, harder to control
Not satisfied, wouldn't switch
Any additional comments regarding this question
Based on this evaluation, would you consider purchasing Wallace needles?
Yes
No
a pop up appears advising there is 10% off their first order (details to be decided with sales on %)
Any additional comments regarding this question
Please can you tell us how we can improve our needles or service to make them suitable for your clinical needs
Needle One
The following questions relate to the evaluation of Needle One
Lot Number
Needle One - Patient Category
<25
26-35
36-45
45-50
Needle One - Patient ID (clinic ref)
Total number of mature folilicles
Number of eggs collected
Number of mature follicles (14mm or greater)
Number of degenerate egg at dedundation (ICSI)
Number of 2 PN embryos
Number of 3PN embryos
Number of embryos that achieved Blastocyst formation
Number of embryos utilized
Was a Clinical PR achieved?
Please select
Yes
No
Unknown to date
Was a LBR achieved?
Please select
Yes
No
Unknown to date
Did embryo miscarry?
Please select
Yes
No
Unknown to date
Needle Two
The following questions relate to the evaluation of Needle Two
Lot Number
Needle Two - Patient Category
<25
26-35
36-45
45-50
Needle Two - Patient ID (clinic ref)
Total number of mature folilicles
Number of eggs collected
Number of mature follicles (14mm or greater)
Number of degenerate egg at dedundation (ICSI)
Number of 2 PN embryos
Number of 3PN embryos
Number of embryos that achieved Blastocyst formation
Number of embryos utilized
Was a Clinical PR achieved?
Please select
Yes
No
Unknown to date
Was a LBR achieved?
Please select
Yes
No
Unknown to date
Did embryo miscarry?
Please select
Yes
No
Unknown to date
Needle Three
The following questions relate to the evaluation of Needle Three
Lot Number
Needle Three - Patient Category
<25
26-35
36-45
45-50
Needle Three - Patient ID (clinic ref)
Total number of mature follicles
Number of eggs collected
Number of mature follicles (14mm or greater)
Number of degenerate egg at dedundation (ICSI)
Number of 2 PN embryos
Number of 3PN embryos
Number of embryos that achieved Blastocyst formation
Number of embryos utilized
Was a Clinical PR achieved?
Please select
Yes
No
Unknown to date
Was a LBR achieved?
Please select
Yes
No
Unknown to date
Did embryo miscarry?
Please select
Yes
No
Unknown to date
Needle Four
The following questions relate to the evaluation of Needle Four
Lot Number
Needle Four - Patient Category
<25
26-35
36-45
45-50
Needle Four - Patient ID (clinic ref)
Total number of mature follicles
Number of eggs collected
Number of mature follicles (14mm or greater)
Number of degenerate egg at dedundation (ICSI)
Number of 2 PN embryos
Number of 3PN embryos
Number of embryos that achieved Blastocyst formation
Number of embryos utilized
Was a Clinical PR achieved?
Please select
Yes
No
Unknown to date
Was a LBR achieved?
Please select
Yes
No
Unknown to date
Did embryo miscarry?
Please select
Yes
No
Unknown to date
Needle Five
The following questions relate to the evaluation of Needle Five
Lot Number
Needle Five - Patient Category
<25
26-35
36-45
45-50
Needle Five - Patient ID (clinic ref)
Total number of mature follicles
Number of eggs collected
Number of mature follicles (14mm or greater)
Number of degenerate egg at dedundation (ICSI)
Number of 2 PN embryos
Number of 3PN embryos
Number of embryos that achieved Blastocyst formation
Number of embryos utilized
Was a Clinical PR achieved?
Please select
Yes
No
Unknown to date
Was a LBR achieved?
Please select
Yes
No
Unknown to date
Did embryo miscarry?
Please select
Yes
No
Unknown to date
Needle Six
The following questions relate to the evaluation of Needle Six
Lot Number
Needle Six - Patient Category
<25
26-35
36-45
45-50
Needle Six - Patient ID (clinic ref)
Total number of mature follicles
Number of eggs collected
Number of mature follicles (14mm or greater)
Number of degenerate egg at dedundation (ICSI)
Number of 2 PN embryos
Number of 3PN embryos
Number of embryos that achieved Blastocyst formation
Number of embryos utilized
Was a Clinical PR achieved?
Please select
Yes
No
Unknown to date
Was a LBR achieved?
Please select
Yes
No
Unknown to date
Did embryo miscarry?
Please select
Yes
No
Unknown to date
Needle Seven
The following questions relate to the evaluation of Needle Seven
Lot Number
Needle Seven - Patient Category
<25
26-35
36-45
45-50
Needle Seven - Patient ID (clinic ref)
Total number of mature follicles
Number of eggs collected
Number of mature follicles (14mm or greater)
Number of degenerate egg at dedundation (ICSI)
Number of 2 PN embryos
Number of 3PN embryos
Number of embryos that achieved Blastocyst formation
Number of embryos utilized
Was a Clinical PR achieved?
Please select
Yes
No
Unknown to date
Was a LBR achieved?
Please select
Yes
No
Unknown to date
Did embryo miscarry?
Please select
Yes
No
Unknown to date
Needle Eight
The following questions relate to the evaluation of Needle Eight
Lot Number
Needle Eight - Patient Category
<25
26-35
36-45
45-50
Needle Eight - Patient ID (clinic ref)
Total number of mature follicles
Number of eggs collected
Number of mature follicles (14mm or greater)
Number of degenerate egg at dedundation (ICSI)
Number of 2 PN embryos
Number of 3PN embryos
Number of embryos that achieved Blastocyst formation
Number of embryos utilized
Was a Clinical PR achieved?
Please select
Yes
No
Unknown to date
Was a LBR achieved?
Please select
Yes
No
Unknown to date
Did embryo miscarry?
Please select
Yes
No
Unknown to date
Needle Nine
The following questions relate to the evaluation of Needle Nine
Lot Number
Needle Nine - Patient Category
<25
26-35
36-45
45-50
Needle Nine - Patient ID (clinic ref)
Total number of mature follicles
Number of eggs collected
Number of mature follicles (14mm or greater)
Number of degenerate egg at dedundation (ICSI)
Number of 2 PN embryos
Number of 3PN embryos
Number of embryos that achieved Blastocyst formation
Number of embryos utilized
Was a Clinical PR achieved?
Please select
Yes
No
Unknown to date
Was a LBR achieved?
Please select
Yes
No
Unknown to date
Did embryo miscarry?
Please select
Yes
No
Unknown to date
Needle Ten
The following questions relate to the evaluation of Needle Ten
Lot Number
Needle Ten - Patient Category
<25
26-35
36-45
45-50
Needle Ten - Patient ID (clinic ref)
Total number of mature follicles
Number of eggs collected
Number of mature follicles (14mm or greater)
Number of degenerate egg at dedundation (ICSI)
Number of 2 PN embryos
Number of 3PN embryos
Number of embryos that achieved Blastocyst formation
Number of embryos utilized
Was a Clinical PR achieved?
Please select
Yes
No
Unknown to date
Was a LBR achieved?
Please select
Yes
No
Unknown to date
Did embryo miscarry?
Please select
Yes
No
Unknown to date
By submitting your information and clicking on the “Submit” button, you are consenting for this data to be used for evaluation purposes only by CooperSurgical. In addition, you also agree to our
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and
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