REPORT OF CONTACTNOTE: k coorofriab, oxie this fonn k comolclcd il bmma a pcmtoaenl rcorC ln lhc tacmnb fotl*. Plcsc ,Io ,tol asa n ltatdl to coadcL lhls fomt.VA OFFICE

Buffal0, Neu YorklDEl{TlFlCATlOtt Nos. (CJC, SS, xss, V, K .rc.)

LAST NAI\IIE-FIRST NAME-I,|DDLE NAIIE OF YETERAII OW or piilt DATE Of CONTAGT

03/ os /2oL4ADORESS OF VETEMN IELEPHOiE NO. (.|F VElEtaF:l't (hE dc ir@ L'ode)

PERSON CONTACTED

Michele BrayleyTYPE OF COI{TACT (ctw*ow)

fleensoml f] isumorue

ADORESS OF PERSOiI CONTACIED TELEPIIOT'E NO. OF PERSOI.I CONTACTED(htchd. Ar.q L'odc)

PERSON WHO CONTACTEO YOU I YFt OF CO?{TAG I (clwk w)

flrrnsour- [ reuenoar

AODflESS OF PERSON WHO COI.ITACTED YOU TELEP}IOIIIE IVO. OF PERSON W.IOCONIACTEO YOt (btclude ua de)

BRIEF STATEi{EM OF INFORMATION REQUESTED AtlD GltlEN (Cqtbw u 14e 2 ttwdal)

As f uaa settlng up my scopea for the day f nollced one of t,he Buction butE,ons haddried fecal matter t/redged inside the neek of the button. The packaglng waa sealed, iEcame up from sterile proceseing that way. Michele Brayley rras ln t.he'endoscopy depb.aE Ehe time, so I gave bhe button to her, aE Ehe is in Ehe infection control dept.

DMSION OA SECTION EXECUIEO BY felg@ruzqrd rlrle)

-

XiJ?$Yr*r rtg AdobeFotmaDBbffir