Customer Support - VitalAire

Are you a new user? (logging an issue for the first time)

Yes
No

Please select one:

I am the user
I am the Parent/Guardian/Caregiver/Spouse of the patient/user

Parent/Guardian/Caregiver/Spouse Name & Surname

Relationship to the patient/user

Gender

Male
Female
Prefer not to disclose

User/patient ID Number or Passport Number (for non-SA residents)

Type of Diabetes

Do you have a Medical Aid?

Yes
No

Medical Aid Name

Plan Name

VitalAire Diabetes Care Consultant Region

Prescribing Doctor

Communication Consent

I consent to receive the following information via multiple communication platforms such as but not limited to email, SMS and/or WhatsApp:

1.) Product information including updates, new product launches and news
2.) Diabetes-related information
3.) Product specials and promotions
4.) Loyalty programme

I consent to receive the following information via multiple communication platforms such as but not limited to email, SMS and/or WhatsApp:

Yes
No

I am

Specify Other

Reporter Name

Patient Name and Surname

Patient DOB

Patient Weight

Contact Number

Email Address

Select the product for which you require support

G6 Dexcom Account Username

G6 Specify Other Insertion Site

G6 Was Paracetamol Taken?

G6 Display Device

G6 Specify Other Device

G6 Is this a Sensor, Transmitter, App, or Receiver Issue?

G6 Sensor Error Type

G6 How long did the issue last?

G6 Which alert displays?

G6 Did you put an Overlay Patch On?

G6 Was the skin exposed to water within 12 hours after insertion?

G6 Is the applicator needle exposed?

G6 Specify Sensor Error Type

G6 Transmitter Error Type

G6 Specify Transmitter Error Type

G7 Dexcom Account Username

G7 Is this a Sensor, App, or Receiver Issue?

G7 Sensor Error Type

G7 Which alert displays?

G7 Did you put an Overlay Patch On?

G7 Was the skin exposed to water within 12 hours after insertion?

G7 Is this a new Sensor?

G7 Specify Sensor Error Type

G7 App Error Type

G7 Specify Receiver Error Type

One+ Dexcom Account Username

One+ Is this a Sensor, App, or Receiver Issue?

One+ Sensor Error Type

One+ Which alert displays?

One+ Did you put an Overlay Patch On?

One+ Was the skin exposed to water within 12 hours after insertion?

One+ Is this a new Sensor?

One+ Specify Sensor Error Type

One+ App Error Type

One+ Specify Receiver Error Type

If you are experiencing an issue with your Tandem Pump where insulin is not being delivered, please contact Customer Tech Support on 0861 339 266 to resolve telephonically

Insulin Used

Specify other insulin

Is this a cartridge, infusion set, pump accessory or pump touchscreen issue?

Infusion Set Type

Infusion Set LOT Nr

Cartridge LOT Nr

Are you able to load a new cartridge and resume Insulin delivery?

If no, Contact Customer Tech Support on 0861 339 266 for immediate assistance

Select Accessory (Lost items are not replacable/reportable)

Specify Tandem Accessory Issue

Is the Touchscreen cracked or shattered?

How did the pump screen become damaged?

(Please attach photos of the damaged pump screen)

Description of Issue

Upload an image to better illustrate the issue.

Max upload 7mb per attachment | Formats: png, jpg, pdf, zip, rar, mp4, mov

Attachment 1

Attachment 2

Attachment 3

Delivery Address

South Africa
Namibia

Namibia Delivery Details

Paramount Pharmacy

Cnr. Heliodoor & Gen. Murtala Ramat Muhammed Streets, 10005, Windhoek, Namibia

Confirm Delivery Address if replacement is authorized

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Privacy Consent

For the processing of personal information for legitimate business purposes and by Obligation of the Law as per the Consumer Protection Act, and Medicines and Substances Related Act: VitalAire collects, stores and uses the information to:

a.) Perform services between the customer and VitalAire Diabetes.
b.) Communicate requested information and support to customers;
c.) Respond to queries, responses or complaints submitted to VitalAire Diabetes;
d.) Invoicing, order processing and delivery with approved VitalAire Diabetes distributors/ approved 3rd party contracted couriers
e.) Compile, process and provide complaint and related product and health information to Dexcom or Tandem for regulatory reporting purposes and post-market surveillance in the USA, Europe and South Africa;
f.) Compile non-personal statistical information about diabetes management.
g.) Reporting from wholesalers/ distributors, medical device serialisation and traceability as required by ISO13485 standards.

Privacy Consent

I agree to the Privacy Consent

About Customer Tech Support

Communication Consent

Namibia Delivery Details

Privacy Consent

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