LifeVac Incident Report

LifeVac Usage Report

LifeVac reporting — ZaZa’s Legacy

Before you start

You’ve just been through something stressful. This form is short and you can take your time.

  • If anyone is in immediate danger, call 000.
  • It’s normal to feel shaken, teary, or wired after a choking emergency.
  • Only share what you’re comfortable sharing — required fields are marked with a *
  • Your information is used to improve safety guidance and device support. We don’t share personal details without written permission.
  • You can pause, come back, or submit with partial info — progress over perfection.

Incident Details

Help us understand the situation.

How LifeVac Was Used

This tells us how the device was used in the moment.

Outcome & Health Info

This helps us see the outcome and if any conditions affected recovery.

Replacement & Follow-Up (optional)

If your device was used, we can send a free replacement mask to ensure your kit stays complete and ready.

Feeling shaken? It’s normal to feel emotional after a choking emergency. If you’d like to talk to someone, you can contact: