AniCell Case Selection & Follow-up

AniCell Case Selection & Follow-up

AniCell Case Selection & Follow-up

Welcome to AniCell’s Online Case/Product Selection and Follow-up System.

To AniCell, next to safety, data is everything. Whether it is the process of case/product selection or follow-up of a case we have already used our products on, systematic data collection is very important for both the monitoring of safety and efficacy outcomes. To that end, if you have safety and efficacy data to report on a case or are wanting assistance to make a case selection decision, please take a moment and describe the case for us.

We track the efficacy and safety of all AniCell products for the FDA and would appreciate a quick response regarding the cases where you have used our products. It does not need to be completely comprehensive; simply provide what you have.

"*" indicates required fields

Type of Submission*

Form used for Product Use Follow-up and Adverse event reporting or as a Case Assistance Request for help on a specific case.

Product Serial Number

Product(s) Serial Number(s) (if you have it, optional)

Veterinarian*

Prefix First Last

Veterinarian*

First Last

Veterinarian Email*

Veterinarian Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please enter state as 2 letter abbreviation.

Owners Name*

This field is hidden when viewing the form

Pet Owners Phone Number

Animal Name or Barn Name*

Species*

Type/Breed of Animal*

Age*

Sex*

Weight in Pounds*

Products Used*

Choose all of the products used on the case. Hold down the [Ctrl] key to choose multiple.

Safety, outcomes and observations

Diagnosis/Injury Date*

Treatment/Checkup Date*

Diagnosis/General Notes*

Brief description of current medical status and presenting problem (e.g., wound, lameness, neurologic dysfunction, date of injury or onset, duration, severity, and progression, etc.) Include significant musculoskeletal, neurologic, wound, systemic abnormalities or comorbidities. Attach all blood work, radiographs, ultrasounds or test results at the bottom.

Treatment Notes

Previous and Current Medical Treatments (including wound care, joint injections, etc.), any relevant surgical interventions, Include rehabilitation, physical therapy, manual therapy, therapeutic ultrasound, laser, PEMF, acupuncture, etc. (type and frequency):

Medications or Supplements

Prescription Medications or alternative therapies-herbal/CBD - Particularly anything that is anti-inflammatory (include dose, route, frequency, and duration/dates).

Problem List or Co-morbidities

Please list animals additional afflictions or co-morbidities that may have bearing on the use of AniCell's products.

Consultation Goals

Please describe the goals for AniCell’s input (e.g., optimize wound healing, delay surgery, reduce inflammation, product recommendations, application protocol, physical therapy, etc.):

Diagnosis Category*

Diagnosis Sub Category - Bone*

Diagnosis Sub Category - Joint*

Diagnosis Sub Category - Tendon / Ligament*

Diagnosis Sub Category - Surgery*

Diagnosis Sub Category - Wound*

Diagnosis Sub Category - Neurological*

Diagnosis Sub Category - Systemic*

Diagnosis Sub Category - Other*

Diagnosis Category

Wound Severity

How Applied

Did the product perform as good or better than existing standard of care?

Optional Picture or Assessment data File upload

Drop files here or

Max. file size: 64 MB.

Upload Blood Work, Pictures, Radiographs or other data particularly before and after pictures. Any uploaded pictures may be used to show the results of product application. All owner and horse data will be redacted.

Severe Adverse Event Reporting

Adverse Events*

Safety Observations

Owner Information

Please list all contact information for the owner including Name, Address, Email, and Mobile Phone.

List of all people present during application of product

List all people who witnessed adverse event and were present for application of the product.

Other Concurrent Clinical Problems or Products (Severe Adverse Event Only)

Were there other concurrent clinical problems? Please list all other concurrent products or treatments given at the time of application or for this diagnosis.

Case Selection

What was the likelihood of success on the chosen indication?

Date of onset of adverse event

Veterinarian Suspicion Level (Severe Adverse Event Only)

Veterinarian's Level of Suspicion that Product Caused the Adverse Event

When the adverse event occurred, treatment with suspected product

Treatment of the Adverse Event

Describe briefly the treatment of the adverse event. Did it abate after stopping the product? Did it reappear after the reintroduction of the product?

Animal Condition

Overall health status when the suspected product was given:

Outcome Data

Outcome Date*

Outcome Summary of Results

Outcome Observations

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Thanks so much for taking the time. This significantly helps us out in our tracking. If providing this information is going to be too challenging, please do not hesitate to let us know that the information is not available. If it is easier to address over the phone, please reach out at 480-477-0150 or at support@anicellbiotech.com.

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Bone - Cysts
Bone - Growth (Exostosis Ringbone)
Bone - Fracture
Bone - Inflammation (Degeneration Navicular)
Bone - Inflammation (Periostitis Sesamoiditis)
Dental - Fissure/socket
Desmitis - Accessory Ligament of DDFT
Desmitis - CCL/ACL
Desmitis - Collateral Ligament
Desmitis - Sesamoidean
Desmitis - Suspensory
Enthesopathy - Ligament/tendon attachment
Joint - Inflammation (Osteoarthritis Sprains)
Joint - Cartilage (OCD Damage)
Joint - Angulation or Bowing
Joint - Degeneration (Laminitis Founder)
Joint - Infection
Myopathy - Muscle disease
Neurological - Pain
Neurological - Nerve (paralysis)
Ocular
Other
Preventative Treatment
Renal Failure
Reproductive
Surgery - Colic
Surgery - Leg
Surgery - Other
Systemic - Infection
Systemic - Non-specific treatment (age)
Systemic - Organs
Tendonitis - SDFT
Tendonitis - DDFT
Wound - Body Laceration
Wound - Habronema
Wound - Head
Wound - Leg Laceration
Wound - Neoplasias