{"id":184,"date":"2024-12-04T17:48:16","date_gmt":"2024-12-04T17:48:16","guid":{"rendered":"https:\/\/www.cpapeurope-classaction.com\/?page_id=184"},"modified":"2025-01-22T18:01:13","modified_gmt":"2025-01-22T18:01:13","slug":"participez-a-laction","status":"publish","type":"page","link":"https:\/\/www.cpapeurope-classaction.com\/fr\/participez-a-laction\/","title":{"rendered":"REJOIGNEZ L'ACTION"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"184\" class=\"elementor elementor-184\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7d7dff5 e-con-full e-flex e-con e-parent\" data-id=\"7d7dff5\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3390ad8 fluentform-widget-submit-button-center fluent-form-widget-step-header-yes fluent-form-widget-step-progressbar-yes fluentform-widget-submit-button-custom elementor-widget elementor-widget-fluent-form-widget\" data-id=\"3390ad8\" data-element_type=\"widget\" data-widget_type=\"fluent-form-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\n            <div class=\"fluentform-widget-wrapper fluentform-widget-custom-radio-checkbox fluentform-widget-align-default\">\n\n                            <div class=\"fluentform-widget-heading\">\n                                        <h3 class=\"fluentform-widget-title\">\n                        JOIN THE ACTION                    <\/h3>\n                                                            <p class=\"fluentform-widget-description\">\n                        By submitting the form, your case will be evaluated by our local speaking team and you will be contacted for follow-up and your potential participation\u00a0in\u00a0the\u00a0lawsuit, or to provide any additional information\u00a0needed.                    <\/p>\n                                    <\/div>\n            \n            <div class='fluentform ff-default fluentform_wrapper_4 ffs_default_wrap'><form data-form_id=\"4\" id=\"fluentform_4\" class=\"frm-fluent-form fluent_form_4 ff-el-form-top ff_form_instance_4_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_4_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">JOIN THE ACTION<\/legend><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"1\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><input type='hidden' name='__fluent_form_embded_post_id' value='184' \/><input type=\"hidden\" id=\"_fluentform_4_fluentformnonce\" name=\"_fluentform_4_fluentformnonce\" value=\"8c630bd71e\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/184\" \/><input type=\"hidden\" name=\"hidden\" value=\"\" data-name=\"hidden\" ><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_names_first_name_' id='label_ff_4_names_first_name_'>First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_4_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your First Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_names_last_name_' id='label_ff_4_names_last_name_'>Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_4_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your Last Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_email' id='label_ff_4_email'>Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_4_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_phone' id='label_ff_4_phone'>Phone fix or mobile<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone ff_el_with_extended_validation\" type=\"tel\" placeholder=\"with country code e.g. +39 123123123\" data-name=\"phone\" id=\"ff_4_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_datetime' id='label_ff_4_datetime'>Date of Birth<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date of Birth Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_4_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_country-list' id='label_ff_4_country-list'>Country of Residence<\/label><\/div><div class='ff-el-input--content'><select name=\"country-list\" id=\"ff_4_country-list\" class=\"ff-el-form-control\" placeholder=\"Select Country\" data-name=\"country-list\" aria-invalid='false' aria-required=true><option value=''>Select Country<\/option><option value='AF' >Afghanistan<\/option><option value='ZA' >Afrique du Sud<\/option><option value='AL' >Albanie<\/option><option value='DZ' >Alg\u00e9rie<\/option><option value='DE' >Allemagne<\/option><option value='AD' >Andorre<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctique<\/option><option value='AG' >Antigua-et-Barbuda<\/option><option value='SA' >Arabie saoudite<\/option><option value='AR' >Argentine<\/option><option value='AM' >Arm\u00e9nie<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australie<\/option><option value='AT' >Autriche<\/option><option value='AZ' >Azerba\u00efdjan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbade<\/option><option value='BE' >Belgique<\/option><option value='BZ' >Belize<\/option><option value='BM' >Bermudes<\/option><option value='BT' >Bhoutan<\/option><option value='BY' >Bi\u00e9lorussie<\/option><option value='BO' >Bolivie<\/option><option value='BQ' >Bonaire, Saint-Eustache et Saba<\/option><option value='BA' >Bosnie-Herz\u00e9govine<\/option><option value='BW' >Botswana<\/option><option value='BN' >Brunei<\/option><option value='BR' >Br\u00e9sil<\/option><option value='BG' >Bulgarie<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='BJ' >B\u00e9nin<\/option><option value='CV' >Cabo Verde<\/option><option value='KH' >Cambodge<\/option><option value='CM' >Cameroun<\/option><option value='CA' >Canada<\/option><option value='CL' >Chili<\/option><option value='CN' >Chine<\/option><option value='CY' >Chypre<\/option><option value='CO' >Colombie<\/option><option value='KM' >Comores<\/option><option value='KP' >Cor\u00e9e du Nord<\/option><option value='KR' >Cor\u00e9e du Sud<\/option><option value='CR' >Costa Rica<\/option><option value='HR' >Croatie<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CI' >C\u00f4te d\u2019Ivoire<\/option><option value='DK' >Danemark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominique<\/option><option value='ES' >Espagne<\/option><option value='EE' >Estonie<\/option><option value='SZ' >Eswatini<\/option><option value='FJ' >Fidji<\/option><option value='FI' >Finlande<\/option><option value='FR' >France<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambie<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GD' >Grenade<\/option><option value='GL' >Groenland<\/option><option value='GR' >Gr\u00e8ce<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernesey<\/option><option value='GN' >Guin\u00e9e<\/option><option value='GQ' >Guin\u00e9e \u00e9quatoriale<\/option><option value='GW' >Guin\u00e9e-Bissau<\/option><option value='GY' >Guyana<\/option><option value='GF' >Guyane<\/option><option value='GE' >G\u00e9orgie<\/option><option value='GS' >G\u00e9orgie du Sud \/ \u00eeles Sandwich<\/option><option value='HT' >Ha\u00efti<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongrie<\/option><option value='IN' >Inde<\/option><option value='ID' >Indon\u00e9sie<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Irlande<\/option><option value='IS' >Islande<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Italie<\/option><option value='JM' >Jama\u00efque<\/option><option value='JP' >Japon<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordanie<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KG' >Kirghizistan<\/option><option value='KI' >Kiribati<\/option><option value='XK' >Kosovo<\/option><option value='KW' >Kowe\u00eft<\/option><option value='LA' >Laos<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Lettonie<\/option><option value='LB' >Liban<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libye<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lituanie<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao S.A.R., Chine<\/option><option value='MK' >Mac\u00e9doine du Nord<\/option><option value='MG' >Madagascar<\/option><option value='MY' >Malaisie<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malte<\/option><option value='MA' >Maroc<\/option><option value='MQ' >Martinique<\/option><option value='MU' >Maurice<\/option><option value='MR' >Mauritanie<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexique<\/option><option value='FM' >Micron\u00e9sie<\/option><option value='MD' >Moldavie<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolie<\/option><option value='MS' >Montserrat<\/option><option value='ME' >Mont\u00e9n\u00e9gro<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibie<\/option><option value='NR' >Nauru<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nig\u00e9ria<\/option><option value='NU' >Niue<\/option><option value='NO' >Norv\u00e8ge<\/option><option value='NC' >Nouvelle-Cal\u00e9donie<\/option><option value='NZ' >Nouvelle-Z\u00e9lande<\/option><option value='NP' >N\u00e9pal<\/option><option value='OM' >Oman<\/option><option value='UG' >Ouganda<\/option><option value='UZ' >Ouzb\u00e9kistan<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palaos<\/option><option value='PA' >Panama<\/option><option value='PG' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='PY' >Paraguay<\/option><option value='NL' >Pays-Bas<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Pologne<\/option><option value='PF' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='PR' >Porto Rico<\/option><option value='PT' >Portugal<\/option><option value='PE' >P\u00e9rou<\/option><option value='QA' >Qatar<\/option><option value='RO' >Roumanie<\/option><option value='GB' >Royaume-Uni (UK)<\/option><option value='RU' >Russie<\/option><option value='RW' >Rwanda<\/option><option value='CF' >R\u00e9publique centrafricaine<\/option><option value='DO' >R\u00e9publique dominicaine<\/option><option value='CG' >R\u00e9publique du Congo (Brazzaville)<\/option><option value='CD' >R\u00e9publique d\u00e9mocratique du Congo (Kinshasa)<\/option><option value='CZ' >R\u00e9publique tch\u00e8que<\/option><option value='RE' >R\u00e9union<\/option><option value='EH' >Sahara occidental<\/option><option value='BL' >Saint-Barth\u00e9lemy<\/option><option value='KN' >Saint-Kitts-et-Nevis<\/option><option value='SM' >Saint-Marin<\/option><option value='MF' >Saint-Martin (Antilles fran\u00e7aises)<\/option><option value='SX' >Saint-Martin (partie n\u00e9erlandaise)<\/option><option value='PM' >Saint-Pierre-et-Miquelon<\/option><option value='VC' >Saint-Vincent-et-les-Grenadines<\/option><option value='SH' >Sainte-H\u00e9l\u00e8ne<\/option><option value='LC' >Sainte-Lucie<\/option><option value='SV' >Salvador<\/option><option value='WS' >Samoa<\/option><option value='AS' >Samoa am\u00e9ricaines<\/option><option value='ST' >Sao Tom\u00e9-et-Principe<\/option><option value='RS' >Serbie<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapour<\/option><option value='SK' >Slovaquie<\/option><option value='SI' >Slov\u00e9nie<\/option><option value='SO' >Somalie<\/option><option value='SD' >Soudan<\/option><option value='SS' >Soudan du Sud<\/option><option value='LK' >Sri Lanka<\/option><option value='CH' >Suisse<\/option><option value='SR' >Suriname<\/option><option value='SE' >Su\u00e8de<\/option><option value='SJ' >Svalbard et Jan Mayen<\/option><option value='SY' >Syrie<\/option><option value='SN' >S\u00e9n\u00e9gal<\/option><option value='TJ' >Tadjikistan<\/option><option value='TZ' >Tanzanie<\/option><option value='TW' >Ta\u00efwan<\/option><option value='TD' >Tchad<\/option><option value='TF' >Terres australes et antarctiques fran\u00e7aises<\/option><option value='PS' >Territoire Palestinien<\/option><option value='IO' >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value='TH' >Thailande<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinit\u00e9-et-Tobago<\/option><option value='TN' >Tunisie<\/option><option value='TM' >Turkm\u00e9nistan<\/option><option value='TR' >Turquie<\/option><option value='TV' >Tuvalu<\/option><option value='UA' >Ukraine<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VA' >Vatican<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis-et-Futuna<\/option><option value='YE' >Y\u00e9men<\/option><option value='ZM' >Zambie<\/option><option value='ZW' >Zimbabwe<\/option><option value='EG' >\u00c9gypte<\/option><option value='AE' >\u00c9mirats arabes unis<\/option><option value='EC' >\u00c9quateur<\/option><option value='ER' >\u00c9rythr\u00e9e<\/option><option value='US' >\u00c9tats-Unis (USA)<\/option><option value='ET' >\u00c9thiopie<\/option><option value='BV' >\u00cele Bouvet<\/option><option value='CX' >\u00cele Christmas<\/option><option value='NF' >\u00cele Norfolk<\/option><option value='IM' >\u00cele de Man<\/option><option value='AX' >\u00celes Aland<\/option><option value='KY' >\u00celes Ca\u00efmans<\/option><option value='CC' >\u00celes Cocos<\/option><option value='CK' >\u00celes Cook<\/option><option value='FK' >\u00celes Falkland<\/option><option value='FO' >\u00celes F\u00e9ro\u00e9<\/option><option value='HM' >\u00celes Heard-et-MacDonald<\/option><option value='MP' >\u00celes Mariannes du Nord<\/option><option value='MH' >\u00celes Marshall<\/option><option value='UM' >\u00celes Mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><option value='SB' >\u00celes Salomon<\/option><option value='TC' >\u00celes Turques-et-Ca\u00efques<\/option><option value='VI' >\u00celes Vierges am\u00e9ricaines (US)<\/option><option value='VG' >\u00celes Vierges britanniques<\/option><\/select><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Have you been using one of the recalled products?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_b37accb15c0b87d53e24bd341bc9d616'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_b37accb15c0b87d53e24bd341bc9d616' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1daea093c941a7fae9c4085a71370e6c'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_1daea093c941a7fae9c4085a71370e6c' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_dropdown' id='label_ff_4_dropdown'>Please select the model from the list<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_4_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_4_dropdown\"><option value=\"\">- Select -<\/option><option value=\"E30 (Emergency Use Authorisation)\"  >E30 (Emergency Use Authorisation)<\/option><option value=\"DreamStation ASV, DreamStation BiPAP autoSV\"  >DreamStation ASV, DreamStation BiPAP autoSV<\/option><option value=\"System One ASV4, System One BiPAP auto SV, System One BiPAP auto SV Advanced\"  >System One ASV4, System One BiPAP auto SV, System One BiPAP auto SV Advanced<\/option><option value=\"OmniLab Advanced PlusSleep Lab Titration Devices\"  >OmniLab Advanced PlusSleep Lab Titration Devices<\/option><option value=\"BiPAP ASV II &amp; III Legacy BiPAP\"  >BiPAP ASV II & III Legacy BiPAP<\/option><option value=\"DreamStation ST, AVAPS, DreamStation BiPAP AVAPS, DreamStation BiPAP S\/T\"  >DreamStation ST, AVAPS, DreamStation BiPAP AVAPS, DreamStation BiPAP S\/T<\/option><option value=\"S\/T C Series, AVAPS, System One BiPAP AVAPS(C Series), System One BiPAP S\/T (CSeries)\"  >S\/T C Series, AVAPS, System One BiPAP AVAPS(C Series), System One BiPAP S\/T (CSeries)<\/option><option value=\"BiPAP Synchrony IILegacy BiPAP\"  >BiPAP Synchrony IILegacy BiPAP<\/option><option value=\"System One 50 series CPAPs, Auto CPAP, BiPAPs\"  >System One 50 series CPAPs, Auto CPAP, BiPAPs<\/option><option value=\"DreamStation CPAP, Auto CPAP, BiPAP\"  >DreamStation CPAP, Auto CPAP, BiPAP<\/option><option value=\"Dorma 400, 500 CPAP, Auto CPAP, BiPAP ASV II &amp; III Legacy BiPAP\"  >Dorma 400, 500 CPAP, Auto CPAP, BiPAP ASV II & III Legacy BiPAP<\/option><option value=\"System One 60 series, CPAPs, Auto CPAP, BiPAPs\"  >System One 60 series, CPAPs, Auto CPAP, BiPAPs<\/option><option value=\"DreamStation GO CPAP, APAP, Auto CPAP\"  >DreamStation GO CPAP, APAP, Auto CPAP<\/option><option value=\"Trilogy 100 Ventilator\"  >Trilogy 100 Ventilator<\/option><option value=\"Trilogy 200 Ventilator\"  >Trilogy 200 Ventilator<\/option><option value=\"Garbin Plus, Aeris, LifeVent Ventilator\"  >Garbin Plus, Aeris, LifeVent Ventilator<\/option><option value=\"A-Series BiPAP Hybrid A30,  BiPAP Hybrid A30Ventilator (A-Series)\"  >A-Series BiPAP Hybrid A30,  BiPAP Hybrid A30Ventilator (A-Series)<\/option><option value=\"A-Series BiPAP V30 Auto Ventilator, BiPAP V30 Auto\"  >A-Series BiPAP V30 Auto Ventilator, BiPAP V30 Auto<\/option><option value=\"A-Series BiPAP A40, BiPAP A40 Ventilator (A-Series)\"  >A-Series BiPAP A40, BiPAP A40 Ventilator (A-Series)<\/option><option value=\"A-Series BiPAP A30, BiPAP A30 Ventilator (A-Series)\"  >A-Series BiPAP A30, BiPAP A30 Ventilator (A-Series)<\/option><option value=\"Other\/I do not know\"  >Other\/I do not know<\/option><\/select><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_dropdown_1' id='label_ff_4_dropdown_1'>Year of first use<\/label><div class=\"ff-el-tooltip\" data-content=\"(Please select the year you started using the device eg. 2014)\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><select name=\"dropdown_1\" id=\"ff_4_dropdown_1\" class=\"ff-el-form-control\" data-name=\"dropdown_1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_4_dropdown_1\"><option value=\"\">- Select -<\/option><option value=\"2008\"  >2008<\/option><option value=\"2009\"  >2009<\/option><option value=\"2010\"  >2010<\/option><option value=\"2011\"  >2011<\/option><option value=\"2012\"  >2012<\/option><option value=\"2013\"  >2013<\/option><option value=\"2014\"  >2014<\/option><option value=\"2015\"  >2015<\/option><option value=\"2016\"  >2016<\/option><option value=\"2017\"  >2017<\/option><option value=\"2018\"  >2018<\/option><option value=\"2019\"  >2019<\/option><option value=\"2020\"  >2020<\/option><option value=\"2021\"  >2021<\/option><option value=\"2022\"  >2022<\/option><option value=\"2023\"  >2023<\/option><option value=\"2024\"  >2024<\/option><\/select><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_dropdown_2' id='label_ff_4_dropdown_2'>Year of last use<\/label><div class=\"ff-el-tooltip\" data-content=\"(Please select the year you stopped using the device eg. 2022)\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><select name=\"dropdown_2\" id=\"ff_4_dropdown_2\" class=\"ff-el-form-control\" data-name=\"dropdown_2\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_4_dropdown_2\"><option value=\"\">- Select -<\/option><option value=\"2008\"  >2008<\/option><option value=\"2009\"  >2009<\/option><option value=\"2010\"  >2010<\/option><option value=\"2011\"  >2011<\/option><option value=\"2012\"  >2012<\/option><option value=\"2013\"  >2013<\/option><option value=\"2014\"  >2014<\/option><option value=\"2015\"  >2015<\/option><option value=\"2016\"  >2016<\/option><option value=\"2017\"  >2017<\/option><option value=\"2018\"  >2018<\/option><option value=\"2019\"  >2019<\/option><option value=\"2020\"  >2020<\/option><option value=\"2021\"  >2021<\/option><option value=\"2022\"  >2022<\/option><option value=\"2023\"  >2023<\/option><option value=\"2024\"  >2024<\/option><option value=\"currently using the device\"  >currently using the device<\/option><\/select><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Do you have the memory card (SD or microSD or other) of your medical device or have you saved a backup?<\/label><div class=\"ff-el-tooltip\" data-content=\"(Usually devices have a memory card to store usage data)\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_a212b9a35f0b7226ceb0b1d5a97ad82e'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_1_a212b9a35f0b7226ceb0b1d5a97ad82e' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_9e9231549fc500023341142fe1c78d0a'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_1_9e9231549fc500023341142fe1c78d0a' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >In case of mechanical ventilators (no sleep apnea devices): have you ever been prescribed the use of one of such breathing devices at home or at a medical facility?<\/label><div class=\"ff-el-tooltip\" data-content=\"(e.g. in intensive care during the pandemic)\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_96c5d4fec8e476386db287803812305a'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_2_96c5d4fec8e476386db287803812305a' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_85be13030fbac60f61d8de39316c6489'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_2_85be13030fbac60f61d8de39316c6489' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_description' id='label_ff_4_description'>If yes, can you indicate where and in what period?<\/label><div class=\"ff-el-tooltip\" data-content=\"(Please state the year, how long for and in which circumstances e.g. hospital, town, country, year etc.)\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_4_description\" name=\"description\" id=\"ff_4_description\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_dropdown_3' id='label_ff_4_dropdown_3'>Mechanical Ventilator model<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_3\" id=\"ff_4_dropdown_3\" class=\"ff-el-form-control\" data-name=\"dropdown_3\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_4_dropdown_3\"><option value=\"\">- Select -<\/option><option value=\"Trilogy 100 Ventilator\"  >Trilogy 100 Ventilator<\/option><option value=\"Trilogy 200 Ventilator\"  >Trilogy 200 Ventilator<\/option><option value=\"Garbin Plus, Aeris, LifeVent Ventilator\"  >Garbin Plus, Aeris, LifeVent Ventilator<\/option><option value=\"I do not know\"  >I do not know<\/option><\/select><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label  >In case you do not know the model, can you contact the healthcare facility and ask them to provide you with brand and model?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_04ae2e6b26c1a8a28a03bf8b0b326ab0'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_4_04ae2e6b26c1a8a28a03bf8b0b326ab0' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_a650ca42ed6e69430623d3cc0030ac2e'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_4_a650ca42ed6e69430623d3cc0030ac2e' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Are you suffering from a medical condition, illness, or injury that might have been cause by the use  of the recalled devices? <\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_37368a389f7f4368ae597505b484900e'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_3_37368a389f7f4368ae597505b484900e' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_f3725e8aa8d4ab8779826f0695098273'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_3_f3725e8aa8d4ab8779826f0695098273' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >If you answered Yes above please select below:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3c3c490ec1eb9cddb878732509340b4b'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Nasal Cavity Tumor\"  id='checkbox_3c3c490ec1eb9cddb878732509340b4b' aria-label='Nasal Cavity Tumor' aria-invalid='false' aria-required=false> <span>Nasal Cavity Tumor<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_e92cdb4686b2faf2c8e2e66236111bfb'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Lung Tumor\"  id='checkbox_e92cdb4686b2faf2c8e2e66236111bfb' aria-label='Lung Tumor' aria-invalid='false' aria-required=false> <span>Lung Tumor<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_d6862ecac8b10c0f7d9e47acc2c80132'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Thyroid Tumor\"  id='checkbox_d6862ecac8b10c0f7d9e47acc2c80132' aria-label='Thyroid Tumor' aria-invalid='false' aria-required=false> <span>Thyroid Tumor<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_fedcc121638bec8be27282c6d3fc3227'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Laryngeal Tumor\"  id='checkbox_fedcc121638bec8be27282c6d3fc3227' aria-label='Laryngeal Tumor' aria-invalid='false' aria-required=false> <span>Laryngeal Tumor<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_22cbfadf1f7d847450be696e45bc6ba1'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Esophageal Tumor\"  id='checkbox_22cbfadf1f7d847450be696e45bc6ba1' aria-label='Esophageal Tumor' aria-invalid='false' aria-required=false> <span>Esophageal Tumor<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_b62a26f0a41c85c4fb985367cc474728'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Oropharyngeal Tumor\"  id='checkbox_b62a26f0a41c85c4fb985367cc474728' aria-label='Oropharyngeal Tumor' aria-invalid='false' aria-required=false> <span>Oropharyngeal Tumor<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5d97a74dca116b6bed408a708ba9238e'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Acute Myeloid Leukemia\"  id='checkbox_5d97a74dca116b6bed408a708ba9238e' aria-label='Acute Myeloid Leukemia' aria-invalid='false' aria-required=false> <span>Acute Myeloid Leukemia<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3ad911beb22057d070b067d22cfae888'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Chronic Myeloid Leukemia\"  id='checkbox_3ad911beb22057d070b067d22cfae888' aria-label='Chronic Myeloid Leukemia' aria-invalid='false' aria-required=false> <span>Chronic Myeloid Leukemia<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_ff3604d4fbcd5ce20d78fccdf7bec4f0'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Asthma\"  id='checkbox_ff3604d4fbcd5ce20d78fccdf7bec4f0' aria-label='Asthma' aria-invalid='false' aria-required=false> <span>Asthma<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_08b3d6f00d7d3cafd46385d28e6b40e7'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Asthma Exacerbation\"  id='checkbox_08b3d6f00d7d3cafd46385d28e6b40e7' aria-label='Asthma Exacerbation' aria-invalid='false' aria-required=false> <span>Asthma Exacerbation<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3981d471544b2f710c12835254511434'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Chronic Bronchitis\"  id='checkbox_3981d471544b2f710c12835254511434' aria-label='Chronic Bronchitis' aria-invalid='false' aria-required=false> <span>Chronic Bronchitis<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_c14d78ba5e5106234d6ce2fc67d15b26'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Exacerbation of Chronic Bronchitis\"  id='checkbox_c14d78ba5e5106234d6ce2fc67d15b26' aria-label='Exacerbation of Chronic Bronchitis' aria-invalid='false' aria-required=false> <span>Exacerbation of Chronic Bronchitis<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_02a876467c6bbe1949a729e2ba0ae0f2'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pneumonia\"  id='checkbox_02a876467c6bbe1949a729e2ba0ae0f2' aria-label='Pneumonia' aria-invalid='false' aria-required=false> <span>Pneumonia<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3ec2040d4cb102cde6941ab70a5ee094'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pulmonary Emphysema\"  id='checkbox_3ec2040d4cb102cde6941ab70a5ee094' aria-label='Pulmonary Emphysema' aria-invalid='false' aria-required=false> <span>Pulmonary Emphysema<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2323cb562d7f0eb154f6f3bbe3e2985c'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Chronic Obstructive Pulmonary Disease\"  id='checkbox_2323cb562d7f0eb154f6f3bbe3e2985c' aria-label='Chronic Obstructive Pulmonary Disease' aria-invalid='false' aria-required=false> <span>Chronic Obstructive Pulmonary Disease<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6d3de09bb5f08fa594f0acfbd6828299'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Other\"  id='checkbox_6d3de09bb5f08fa594f0acfbd6828299' aria-label='Other' aria-invalid='false' aria-required=false> <span>Other<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Have you ever received a recall letter regarding any such devices?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_6a7104ec142a6975ded7a78b047dd3e2'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_5_6a7104ec142a6975ded7a78b047dd3e2' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_b485514825581a3ed299e9330c7f0c7f'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_5_b485514825581a3ed299e9330c7f0c7f' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_dropdown_4' id='label_ff_4_dropdown_4'>If yes, select year and month <\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_4\" id=\"ff_4_dropdown_4\" class=\"ff-el-form-control\" data-name=\"dropdown_4\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_4_dropdown_4\"><option value=\"\">- Select -<\/option><option value=\"2021\"  >2021<\/option><option value=\"2022\"  >2022<\/option><option value=\"2023\"  >2023<\/option><option value=\"2024\"  >2024<\/option><\/select><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_dropdown_5' id='label_ff_4_dropdown_5'>Month (e.g. 5 = May)<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_5\" id=\"ff_4_dropdown_5\" class=\"ff-el-form-control\" data-name=\"dropdown_5\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_4_dropdown_5\"><option value=\"\">- Select -<\/option><option value=\"1\"  >1<\/option><option value=\"2\"  >2<\/option><option value=\"3\"  >3<\/option><option value=\"4\"  >4<\/option><option value=\"5\"  >5<\/option><option value=\"6\"  >6<\/option><option value=\"7\"  >7<\/option><option value=\"8\"  >8<\/option><option value=\"9\"  >9<\/option><option value=\"10\"  >10<\/option><option value=\"11\"  >11<\/option><option value=\"12\"  >12<\/option><\/select><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Are you a relative (e.g. mother\/father, bother\/sister) to a person that has been using a recalled product?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_6_cc762a7a1dfd39e5dd88680b524bfe1c'><input  type=\"radio\" name=\"input_radio_6\" data-name=\"input_radio_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_6_cc762a7a1dfd39e5dd88680b524bfe1c' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_6_97f833f57dca146bf22e5c0df4d66b7a'><input  type=\"radio\" name=\"input_radio_6\" data-name=\"input_radio_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_6_97f833f57dca146bf22e5c0df4d66b7a' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Conditions g\u00e9n\u00e9rales\u00a0: I have read and agree to the Privacy&amp;Coockie Policy contient 1 lien. Utilisez la navigation par onglets pour \u00e9valuer.' class='ff-el-form-check-label ff_tc_label' for='terms-n-condition_da86709ae2129820c9df63afa8f8a42f'><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms-n-condition\" class=\"ff-el-form-check-input\" data-name=\"terms-n-condition\" id=\"terms-n-condition_da86709ae2129820c9df63afa8f8a42f\"  value='on' aria-invalid='false' aria-required=false><\/span> <div class='ff_t_c'><p>I have read and agree to the <span style=\"color: #0e81c7\"><a style=\"color: #0e81c7\" href=\"\/privacy-policy\/\">Privacy&amp;Coockie Policy<\/a><\/span><\/p><\/div><\/label><\/div><\/div><div class='ff-form-inline-style' hidden><style>form.fluent_form_4 .ff-btn-submit:not(.ff_btn_no_style) { background-color: var(--fluentform-primary); color: #ffffff; }<\/style><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\"  aria-label=\"Submit\">Submit<\/button><\/div><\/fieldset><\/form><div id='fluentform_4_errors' class='ff-errors-in-stack ff_form_instance_4_1 ff-form-loading_errors ff_form_instance_4_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_4_1 = {\"id\":\"4\",\"ajaxUrl\":\"https:\\\/\\\/www.cpapeurope-classaction.com\\\/wp-admin\\\/admin-ajax.php\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"asteriskPlacement\":\"asterisk-right\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"cssClassName\":\"\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_4_1\",\"form_id_selector\":\"fluentform_4\",\"rules\":{\"names[first_name]\":{\"required\":{\"value\":true,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"names[middle_name]\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"names[last_name]\":{\"required\":{\"value\":true,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"email\":{\"required\":{\"value\":true,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true},\"email\":{\"value\":true,\"message\":\"Ce champ doit contenir un e-mail valide\",\"global_message\":\"This field must contain a valid email\",\"global\":true}},\"phone\":{\"required\":{\"value\":false,\"global\":true,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\"},\"valid_phone_number\":{\"value\":true,\"global\":true,\"message\":\"Le num\\u00e9ro de t\\u00e9l\\u00e9phone est invalide\",\"global_message\":\"Phone number is not valid\"}},\"datetime\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"country-list\":{\"required\":{\"value\":true,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio\":{\"required\":{\"value\":true,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"dropdown\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"dropdown_1\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"dropdown_2\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio_1\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio_2\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"description\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"dropdown_3\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio_4\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio_3\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio_5\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"dropdown_4\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"dropdown_5\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio_6\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}},\"terms-n-condition\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is required\",\"global\":true}}},\"debounce_time\":300,\"conditionals\":{\"description\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_2\",\"value\":\"yes\",\"operator\":\"=\"}]},\"dropdown_3\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_2\",\"value\":\"yes\",\"operator\":\"=\"}]},\"input_radio_4\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_2\",\"value\":\"yes\",\"operator\":\"=\"}]},\"ff_cn_id_4\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_5\",\"value\":\"yes\",\"operator\":\"=\"}]},\"dropdown_4\":{\"conditions\":[],\"status\":false,\"type\":\"any\",\"container_condition\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_5\",\"value\":\"yes\",\"operator\":\"=\"}]}},\"dropdown_5\":{\"conditions\":[],\"status\":false,\"type\":\"any\",\"container_condition\":{\"type\":\"any\",\"status\":true,\"conditions\":[{\"field\":\"input_radio_5\",\"value\":\"yes\",\"operator\":\"=\"}]}}},\"file_upload_settings\":[]};\n                            <\/script>\n                        <\/div>\n\n            \t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>JOIN THE ACTION By submitting the form, your case will be evaluated by our local speaking team and you will be contacted for follow-up and your potential participation\u00a0in\u00a0the\u00a0lawsuit, or to provide any additional information\u00a0needed. JOIN THE ACTION &#916; First NameLast NameEmailPhone fix or mobileDate of BirthCountry of ResidenceSelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-184","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.cpapeurope-classaction.com\/fr\/wp-json\/wp\/v2\/pages\/184","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.cpapeurope-classaction.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.cpapeurope-classaction.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.cpapeurope-classaction.com\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.cpapeurope-classaction.com\/fr\/wp-json\/wp\/v2\/comments?post=184"}],"version-history":[{"count":22,"href":"https:\/\/www.cpapeurope-classaction.com\/fr\/wp-json\/wp\/v2\/pages\/184\/revisions"}],"predecessor-version":[{"id":918,"href":"https:\/\/www.cpapeurope-classaction.com\/fr\/wp-json\/wp\/v2\/pages\/184\/revisions\/918"}],"wp:attachment":[{"href":"https:\/\/www.cpapeurope-classaction.com\/fr\/wp-json\/wp\/v2\/media?parent=184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}