Model 4000 User Training Manual Issue 4

8/3/2016

07515

UK Sales Vitalograph Ltd. Maids Moreton, Buckingham, MK18 1SW, England Phone: (01280) 827110 Fax: (01280) 823302 e­mail: [email protected] www.vitalograph.co.uk Export Sales Vitalograph Ltd. Maids Moreton, Buckingham, MK18 1SW, England Phone: +44 1280 827120 Fax: +44 1280 823302 e­mail: [email protected] www.vitalograph.eu Vitalograph GmbH Rellinger Straße 64a, 20257 Hamburg, Germany Phone: (040) 54 73 91­0 Fax: (040) 547 391 40 e­mail: [email protected] www.vitalograph.de Vitalograph Inc. 13310 West 99th Street, Lenexa, Kansas 66215, U.S.A. Toll Free: 800 255 6626 Phone: (913) 730­3200 Fax: (913) 730­3232 e­mail: [email protected] www.vitalograph.com Vitalograph (Irl.) Ltd. Gort Road Business Park, Ennis, Co. Clare, Ireland Phone: (065) 6864100 Fax: (065) 6829289 e­mail: [email protected] www.vitalograph.ie © Copyright Vitalograph 2013 Current Edition (Issue 4) Cat. No. 07515 is a registered trademark

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Table of Contents 1. WARNINGS AND ADVISORY NOTICES 2. MAIN COMPONENTS OF THE VITALOGRAPH LUNG MONITOR USB 3. WHAT IS THE VITALOGRAPH LUNG MONITOR USB USED FOR? 4. HOW TO USE THE VITALOGRAPH LUNG MONITOR USB 1. SETTING PERSONAL BEST (REFERENCE) VALUES 2. SETTING MANAGEMENT ZONES 3. PERFORMING THE TEST 4. REVIEWING PREVIOUS RESULTS 5. DELETING ALL RESULTS HISTORY 6. SENDING TEST RESULTS TO VITALOGRAPH REPORTS 5. CARE AND CLEANING OF THE VITALOGRAPH LUNG MONITOR USB 1. HOME USE CLEANING AND DISINFECTION OF THE VITALOGRAPH LUNG MONITOR USB 2. CLEANING AND DISINFECTING THE VITALOGRAPH LUNG MONITOR IN CLINIC USE 1. Table of Materials Used & Cleaning/Disinfection Methods 2. Removing the Flowhead for Cleaning and Disinfecting 6. CONSUMABLES, ACCESSORIES AND SPARE PARTS 7. EXPLANATION OF SYMBOLS 8. TECHNICAL SPECIFICATIONS 9. CE NOTICE 10. FDA NOTICE 11. DECLARATION OF CONFORMITY 12. GUARANTEE

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1. WARNINGS AND ADVISORY NOTICES Note: Please read all the information in this manual before using the Vitalograph lung monitor USB device. A full set of instructions, including cleaning instructions, is available at www.vitalograph.co.uk. The Vitalograph lung monitor is recommended for single patient use. The Vitalograph lung monitor should be only used under the supervision of a healthcare professional. Symptoms must take precedence over device measurements*. If the device is used for longer than its specified life, the accuracy of the device may deteriorate. Before use, ensure that the batteries do not exceed their shelf life, as indicated on the batteries. Store in a clean dry place. * If the patient at home thinks that the device is not reading correctly, they must advise the healthcare professional immediately. Medical facilities may use a precision syringe to check the accuracy of this device.

2. MAIN COMPONENTS OF THE VITALOGRAPH LUNG MONITOR USB

A

Keypad ­ Up, Down & Enter Button

B

LCD

C

Flowhead

D

USB Connector On/Off Button Down Button Up Button Enter Button

3. WHAT IS THE VITALOGRAPH LUNG MONITOR USB USED FOR? The Vitalograph lung monitor USB is an easy to use home monitoring device designed to record key lung function parameters for those with respiratory conditions, including cystic fibrosis and transplant patients. The lung monitor can also be used in primary and secondary care, occupational health and clinical studies. The primary features of the Vitalograph lung monitor are: file:///C:/Users/Owner/Downloads/07515.html

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Measures FEV1, FEV6 and the ratio Displays % of personal best FEV1 Simple to use Electronic record, eliminating need for record cards Stores 200 test sessions Quality of blow indicator FEV1 zones can be personalized Uses disposable AAA batteries

4. HOW TO USE THE VITALOGRAPH LUNG MONITOR USB 4.1. Setting Personal Best (Reference) Values Personal Best (reference) values can be set for forced expiratory volume after 1 second (FEV1). To set the Personal Best (reference) FEV1, follow these steps: 1. Turn the device on,

.

2. When the device is ready for a test ( ), press the

and

3. The reference FEV1 value is set by pressing the

button and releasing when the value is

reached. Press the

buttons together for 3 seconds.

to roll back. The values will increase/decrease in values of 0.10. If the

button is kept depressed, the values will scroll faster. 4. Press ENTER

to keep this reference FEV1 value. The device will return to the test screen.

Note: to de­activate zones, set the FEV1 reference value to 0.00.

4.2. Setting Management Zones The Vitalograph lung monitor can be set for use with 3 or 4 zone management plans. The zone percentages are factory set to 2 boundaries, 95% & 90%, i.e. 3 Zones (95­100%, 90­95%, 0­90%). For 4 zones the middle boundary is set last. The colour systems for each zone type are as follows;

To set the boundary percentage values for 3 zones, follow these steps; 1. Turn the device on,

.

2. When the device is ready for a test ( ), press the

and

buttons together for

approximately 10 seconds. 3. The top (Green/Yellow) boundary can now be set. This is done by pressing the

or

button

and releasing when the value is reached. 4. Press ENTER

to set the top (Green/Yellow) boundary value.

5. The bottom (Yellow/Red) boundary can now be set. This is done by pressing the and releasing when the value is reached. Press

or

button

to set the bottom(Yellow/Red) boundary

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6. Only 2 boundaries are required for the 3 zone system, so the next value should be selected as 0% (default). Press

. The device will return to the test screen.

To set the boundary percentage values for 4 zones, follow these steps; 1. First, set the top and bottom boundaries – see above procedure (steps 1 ­ 6). 2. The middle (Yellow/Orange) boundary can now be set. This is done by pressing the

button

and releasing when the middle boundary value is reached. The values will increase/decrease in values of 1% after an initial jump to the lower boundary value. If the button is kept depressed, the values will scroll faster. This boundary value cannot be set at a value that is greater than the top boundary value or less than the bottom boundary value. 3. Press

to set the middle (Yellow/Orange) boundary value. The device will return to the test

screen.

4.3. Performing the Test 1. Sit down when blowing into the device (unless the physician advises otherwise). 2. Turn the device on,

. with the mouthpiece inserted. (Use a disposable SafeTway mouthpiece

in clinic.) 3. When the device is ready for a test ( ), holding the head high, breathe in as deeply as possible, hold the Vitalograph lung monitor ready in front of the mouth. 4. Holding the breath, place the mouthpiece into the mouth, biting the mouthpiece lightly, and with the lips firmly sealed around it. 5. Blow out as HARD, as FAST and as LONG as possible (the device will stop taking readings after 6 seconds). Be careful not to block the mouthpiece with the tongue or teeth. A ‘spitting’ action will give false readings. 6. Following each blow and at the end of the test session, the FEV1 value will be displayed and below that, FEV1 % Personal Best results for that blow. 7. Pressing the

button will show the FEV6 result.

8. Pressing the

button again will show the FEV1/FEV6 result.

9. Pressing the

button again will show the FEF25­75 result.

10. With the blow icon showing, blow again ( ). Usually 3 blows are required. 11. To view the best test in the session (best FEV1 and best FEV6), press the

button. This is

the value that is recorded for the session in the device history. Note: if an exclamation mark ! appears, this means it was not a good quality blow and the subject should blow again. ! appears when: The Vext (extrapolated volume) is > 5% or 150mL of FEV6 or a cough is detected in the 1st second. If the subject experiences dizziness or fatigue during the test session, wait until this passes before blowing again or terminate the session.

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4.4. Reviewing Previous Results The Vitalograph lung monitor can store up to 200 test sessions. In order to view previously performed test sessions, follow these steps: 1. Turn the device on,

.

2. When the device is ready for a test ( ), press the

button for approximately 3 seconds.

3. The most recent test session will now be displayed. The best FEV1 result will be displayed for approximately 3 seconds, followed by the best FEV6 result. The session number ‘1’ is also displayed, this is the latest session. 4. Earlier test sessions can also be viewed. Pressing the

button once will show ‘2’ the previous

test, and so on. 5. Press

. The device will return to the test screen.

4.5. Deleting All Results History Caution:Once the history has been deleted it cannot be recovered. To delete the history entirely, i.e. all previously stored session results, follow these steps: 1. Turn the device on,

.

2. When the device is ready for a test ( ), press the

and

buttons simultaneously for

approximately 10 seconds. 3. A long beep will indicate success and the device will return to the test screen.

4.6. Sending Test Results to Vitalograph Reports The test session may be transmitted to the Vitalograph Reports Utility on your PC where it can be stored as a PDF file and viewed or printed. Before you can transmit you must first have the Vitalograph Reports Utility installed and running on your PC. If the ‘Snake V’ icon is showing in your PC System Tray then the utility is running, if not refer to Vitalograph Reports Utility instructions. 1. Connect the Vitalograph lung monitor USB device to the PC using the USB cable supplied. 2. On Vitalograph Reports ensure ‘Vitalograph lung monitor’ is selected as the device. 3. There are two ways to print the test results from the lung monitor: a. When the device is ready for a test ( ), press the will show the Report icon (

).

b. After completing the test session, press the displayed. Press

button for 3 seconds on the device

or

button until the print ( ) screen is

.

4. On the Vitalograph Reports enter the Subject Demographic details and Comments. Select ‘Continue’ on Vitalograph Reports when you are finished entering the information. 5. Select a location for the test report on your PC as requested by Vitalograph Reports. A PDF of the test results will appear and will also be stored to the PC.

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5. CARE AND CLEANING OF THE VITALOGRAPH LUNG MONITOR USB 5.1. Home use cleaning and disinfection of the Vitalograph lung monitor The Vitalograph lung monitor should continue to give reliable measurements for up to three years in home use. Then replace it with a new device. Keep it clean and dust free. If you suspect the device is damaged or is measuring incorrectly, contact the doctor immediately. The mouthpiece is the only part of the device, which needs to be routinely cleaned in home use. The outer surfaces should be thoroughly cleaned every week, more often if necessary. We recommend the use of an ordinary alcohol wipe, paying special attention to the mouthpiece area.

Part

Material

Cleaning Recommendation

Disinfection Recommendation

Plastic Mouthpieces

ABS

Wash in warm soapy water. Rinse in clean water

Cold liquid, e.g. Effervescent Chlorine solution

Body

ABS

Wipe with a damp cloth

Alcohol wipe (IPA 70­ 90%)

Fascia

PMMA/ PET

Wipe with a damp cloth

Alcohol wipe (IPA 70­ 90%)

Buttons

Synthetic Rubber

Wipe with a damp cloth

Alcohol wipe (IPA 70­ 90%)

5.2. Cleaning and Disinfecting the Vitalograph lung monitor In Clinic Use A new mouthpiece (either SafeTway or BVF) should be used for each subject. A delay of at least 5 minutes should be allowed between subjects to allow settling of previously aerosolized particles in the measuring device. It is recommended that the device be regularly cleaned according to the guidelines of the user’s facility. The disinfection materials and procedures applied in the users’ facility may be more appropriate than the methods outlined below. In the event of visible contamination of the flowhead element, it should be cleaned or disinfected as described in the accompanying table. The device should be replaced in the event of damage, or if visibly contaminated. The frequency of cleaning and disinfecting is dependent on the facility’s risk assessment, usage, and test environment, but it should be at least monthly or every 100 subjects (300 blows). It is recommended that the device be replaced annually or test and calibration serviced at least annually. There is no planned preventive maintenance for this medical device.

5.2.1. Table of Materials Used & Cleaning/Disinfection Methods This listing of materials used is given to provide clinical users with information to allow the assessment of other cleaning and disinfecting procedures available in the facility on this device.

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Part

Material

Clean/ Disinfect

Autoclave Possible?

Recommended Disinfectants

Plastic Mouthpiece

ABS

Do not use No in clinic

Disinfect by immersion in sodium dichloroisocyanurate solution at 1000ppm concentration of free chlorine for 15 minutes

SafeTway mouthpiece or BVF

Cardboard/ ABS

Dispose – single use

No

Dispose – single use

Case Exterior

ABS

Clean

No

Fascia

PMMA/ PET

Clean

No

Wiping with a 70% isopropyl alcohol impregnated cloth provides a suitable form of cleaning and low­level disinfection. This may be preceded by cleaning with an anti­static foam cleaner if necessary.

Removable flowhead

ABS, Stainless Steel

Clean

No

Disinfect by immersion in sodium dichloroisocyanurate solution at 1000 ppm concentration of free chlorine for 15 minutes.

All external parts of the Vitalograph lung monitor require cleaning, i.e. the removal of visible particulate contamination. The parts of the device that make up the flowhead, which comes into contact with the breath of the subjects being tested, also require disinfecting. This device is not designated as a ‘sterile’ device. Definitions of cleaning and disinfection are as defined in “Sterilization, Disinfection and Cleaning of Medical Equipment: Guidance on Decontamination from the Microbiology Committee to Department of Health Medical Devices Directorate, 1996”. Recommendations for chemical disinfectants are derived from the PHLS publication “Chemical Disinfection in Hospitals” 1993.

5.2.2. Removing the Flowhead for Cleaning and Disinfecting

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Flowhead Disassembled

Flowhead Assembled

1. Remove the flowhead from the body with a sharp pulling motion. 2. Clean the flowhead by washing in a mild detergent to remove particulate contamination, taking care not to touch the moving vanes. Swill vigorously in water with mild detergent. Do not attempt to “rub” or “scrub” in the area of the vanes. Rinse with clean water. 3. Disinfect by immersion in sodium dichloroisocyanurate solution at 1000 ppm concentration of free chlorine for 15 minutes. Prepare disinfectant solution as directed in the manufacturer’s guidelines. Rinse with warm water for faster drying. 4. Leave it to dry completely before reassembling. Drying the flowhead may require placing it in a warm place overnight. A drying cabinet is ideal.

Wiping with a 70% Isopropyl Alcohol impregnated cloth provides a suitable form of cleaning and low­level disinfection for the case exterior, display, screen surround and keys. Repeat this at least weekly to prevent a build­up of grime from normal handling and use. Always follow the safety guidelines given by the manufacturer of cleaning and disinfectant chemicals or equipment. Reassemble the flowhead by pushing back on until it ‘clicks’ into position. Ensure that the flowhead is pushed fully home. When the flowhead is reassembled, it is good practice with any respiratory measuring device for an accuracy check to be performed using a 3L Precision Syringe. An accuracy of +/­ 3.5% should be achieved. Device is within limits if it passes the check using either a 1 second or a 3 second syringe stroke speed.(FEV6 reading should be used).

6. CONSUMABLES, ACCESSORIES AND SPARE PARTS

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Cat. No Description 40168 Mouthpiece (20) 20242 SafeTway Mouthpieces (200) 20303 Disposable Noseclips (200) 20980 Mini SafeTway mouthpieces (50) 20991 Long SafeTway mouthpieces (130) 28350 BVF Bacterial/Viral Filters (50) 40167 Pouch Spare (x10)

7. EXPLANATION OF SYMBOLS Type BF equipment Class II USB Connector Attention (reference relevant section in manual) Manufacturer Year of Manufacture The device must be taken to separate collection at the product end­of­life. Do not dispose of these products as unsorted municipal waste. Other Labels Battery status Battery status Full Battery status Half Battery status Quarter Battery status Empty (flashing)

Blow Now Symbol !

Bad Test Symbol (Slow start or Cough) Transmit Report Symbol

Memory 90% ­ 100% Full Icon Flashes when memory reaches 100%

8. TECHNICAL SPECIFICATIONS

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Material:

PC/ABS

Accuracy:

Better than ± 3%

Flow Impedance:

Better than 0.15kPa/L/s at 14L/s

Measurement Range:

0 – 9.99 L BTPS

Performance And Safety Standards:

ISO EN 23747:2007 ATS/ERS Guidelines 2005

Electromagnetic emissions:

CISPR 11 Group 1 (battery operated)

Electromagnetic immunity:

IEC 61000­4­2, IEC 61000­4­3 (battery operated)

Sensor:

Stator/rotor

Power Supply:

2 x AAA batteries

Operating Temperature:

17 – 37°C

! Bad Test Criteria:

Slow start of test (Vext>5%) or a cough detected in the first second

Auto power down time

Set to 2 minutes as standard

Communications

USB

9. CE NOTICE Marking by the symbol indicates compliance of the Vitalograph 4000 Respiratory Monitor lung monitor device to the Medical Devices Directive of the European Community. Such marking is indicative that the Vitalograph 4000 Respiratory Monitor lung monitor device meets or exceeds the following technical standards:

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Guidance and manufacturer’s declaration – electromagnetic emissions

The 4000 Respiratory Monitor lung monitor is intended for use in the electromagnetic environment specified below. The customer or the user of 4000 Respiratory Monitor lung monitor should assure that it is used in such an environment.

Emissions test

Compliance

Electromagnetic environment – guidance

RF emissions CISPR 11

Group 1

The 4000 Respiratory Monitor lung monitor uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment.

RF emissions CISPR 11

Class B

The 4000 Respiratory Monitor lung monitor is suitable for use in all establishments, including domestic establishments and those directly connected to the public low­voltage power supply network that supplies buildings used for domestic purposes.

Harmonic emissions IEC 61000­3­2

Class A

Voltage fluctuations/ flicker emissions IEC 61000­3­3

Class A

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Guidance and manufacturer’s declaration – electromagnetic immunity

The 4000 Respiratory Monitor lung monitor is intended for use in the electromagnetic environment specified below. The customer or the user of the 4000 Respiratory Monitor lung monitor should assure that it is used in such an environment.

Immunity test

IEC 60601 Test level

Compliance level

Electromagnetic environment­ guidance

Electrostatic discharge (ESD) IEC 61000­4­2

±6 kV contact

±6 kV contact

±8 kV air

±8 kV air

Floors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%

Electrical fast transient/burst IEC 61000­4­4

±2 kV for power supply Battery operated lines device ±1 kV for input/ output lines

Surge IEC 61000­4­5

±1kV differential mode ±2kV common mode

Voltage dips, short interruptions and voltage variations on power supply input lines

<5 % 100V (>95% dip Battery operated in 100V) for 0,5 cycle device 40 % 100V (60% dip in 100V) for 5 cycles 70 % 100V (30% dip in 100V) for25 cycles <5% 100V (>95% dip in 100V) for 5 sec

IEC 61000­4­11

Power frequency (50/60 Hz) magnetic field IEC 61000­4­8

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3 A/m

Battery operated device

Performance A

Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment.

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Guidance and manufacturer’s declaration – electromagnetic immunity

The 4000 Respiratory Monitor lung monitor is intended for use in the electromagnetic environment specified below. The customer or the user of the 4000 Respiratory Monitor lung monitor should assure that it is used in such an environment.

Immunity test

Conducted RF IEC 61000­4­6

Radiated RF IEC 61000­4­3

IEC 60601 Test level

10 Vrms 150kHz to 80 MHz in ISM bands

3 V/m 80 MHz to 2,5 GHz

Compliance level

Battery operated device

Electromagnetic environment ­ guidance

Portable and mobile RF communications equipment should be used no closer to any part of the 4000 Respiratory Monitor lung monitor including cables, than the recommended separation distance calculated form the equation applicable to the frequency of the transmitter. Recommended separation distance

3V/m from 80MHz to 2.5 GHz

80MHz to 800MHz 800MHz to 2.5GHz Where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in metres (m). Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be less than the compliance level in each frequency range. Interference may occur in the vicinity of equipment marked with the following symbol:

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Recommended separation distances between portable and mobile RF communication equipment and the 4000 Respiratory Monitor lung monitor

The 4000 Respiratory Monitor lung monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the 4000 Respiratory Monitor lung monitor can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the 4000 Respiratory Monitor lung monitor as recommended below, according to the maximum output power of the communications equipment.

Rated maximum output power of transmitter

Separation distance according to frequency of transmitter (m)

W

150 kHz to 80 MHz d = 1.2 √P

80 MHz to 800 MHz 800 MHz to 2.5GHz d = 1.2√P d = 2.3√P

0.01

0.1m

0.1m

0.2m

0.1

0.4m

0.4m

0.7m

1

1.2m

1.2m

2.3m

10

3.7m

3.7m

7.4m

100

11.7m

11.7m

23.3m

For transmitters rated at a maximum output power not listed above, the recommended separation distance d in metres (m) can be estimated using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (w) according to the transmitter manufacturer. NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies. NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people. Medical Devices may be affected by cellular telephones and other personal or household devices not intended for medical facilities. It is recommended that all equipment used near the Vitalograph product comply with the medical electromagnetic compatibility standard and to check before use that no interference is evident or possible. If interference is suspected or possible, switching off the offending device is the normal solution, as is required in aircraft and medical facilities. Medical electrical equipment needs special precautions regarding EMC and needs to be installed and put into service according to the EMC information provided. Portable and mobile RF communications equipment can affect medical electrical equipment.

10. FDA NOTICE file:///C:/Users/Owner/Downloads/07515.html

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Caution: Federal Law restricts this device to sale by, or on the order of a physician.

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11. DECLARATION OF CONFORMITY

Product: Vitalograph 4000 Respiratory Monitor lung monitor Vitalograph hereby ensures and declares that the above product associated with this user manual, is designed and manufactured in accordance with the following QMS regulations and standards: European Medical Devices Directive {MDD} 93/42/EEC. This device, classified as 2a as per Annex IX of MDD 93/42/EEC, meets the following provisions of Annex II of the Medical Devices Directive as per Article 11, section 3a, excluding point 4 of Annex II. This device complies with the EMC Directive 89/336/EC, conformance demonstrated by following standard EN60601­1­2:2001. Equipment classification: Residential. Canadian Medical Device Regulation {CMDR} FDA Quality System Regulation {QSR} 21 CFR 820. EN ISO 13485: 2003. Medical devices. Quality management systems. Requirements for regulatory purposes. Certifying Body {for 93/42/EEC and CMDR}: British Standards Institute {BSI} Certificate Nos. CE 00772, MD 82182, FM 83550 Signed on behalf of Vitalograph (Ireland) Ltd.

B. R. Garbe. Group Managing Director

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12. GUARANTEE Subject to the conditions listed below, Vitalograph Ltd. and its associated companies, (hereinafter called the Company) guarantee to repair or at its opinion replace any component thereof, which, in the opinion of the Company is faulty or below standard as a result of inferior workmanship or materials. The conditions of this Guarantee are: 1. This Guarantee shall only apply to hardware defects which are notified to the Company or to its accredited distributor within 1 year of the date of purchase of the equipment, unless otherwise agreed in writing by the Company 2. Software (meaning computer software, or user installable modules) is guaranteed for 90 days from the date of purchase. 3. The Company warrants that the software when correctly used in conjunction with the hardware will perform in the manner described in the Company's literature and user manuals. The Company undertakes to rectify at no expense to the customer any software failure notified within the period stated above, provided that the failure can be recreated and the software has been installed and used in accordance with the user manual. Notwithstanding this clause, the software is not warranted to be free of errors. 4. This Guarantee does not cover any faults caused by accident, misuse, neglect, tampering with the equipment, use of consumable items or parts not approved by the Company, or any attempt at adjustment or repair other than by personnel accredited by the Company, nor does it cover reinstatement of any configuration changes caused by the installation of any software. 5. If a defect occurs, please contact the supplier from whom it was purchased for advice. The Company does not authorise any person to create for it any other obligation or liability in connection with Vitalograph® equipment 6. This Guarantee is not transferable and no person, firm or company has any authority to vary the terms or conditions of this Guarantee. 7. To the maximum extent permitted by law, the Company does not accept liability for any consequential damages arising out of the use of, or inability to use any Vitalograph® equipment. 8. This Guarantee is offered as an additional benefit to the Consumer’s statutory rights and does not affect these rights in any way. This Guarantee is offered as an additional benefit to the Consumer’s statutory rights and does not affect these rights in any way.

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