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In November 2013, 17-year-old Torin Yater-Wallace suffered a penetrating right lung injury related to dry needling performed by a physical therapist. The penetrating right lung injury resulted in a traumatic pneumothorax (an accumulation of air in the pleural cavity resulting from blunt or penetrating chest injury and causing lung collapse). He was treated for the traumatic pneumothorax at the emergency department of the St. Anthony Summit Medical Center in Frisco, Colorado, and was admitted to that hospital on the same day. The traumatic pneumothorax required medical and surgical intervention. He was hospitalized for five days. (Photo: @TorinWallace)

 
 
 

Dry Needling Adverse Event Reporting System (DNAERS) Form

To report a serious adverse event related to dry needling performed by an unqualified practitioner of acupuncture, such as a physical therapist, use the Dry Needling Adverse Event Reporting System (DNAERS) form. The National Center for Acupuncture Safety and Integrity (NCASI) will use the information as part of our legislative and administrative advocacy work.

Note: Items marked with an asterisk (*) are required.

A. PATIENT INFORMATION
NCASI recognizes that privacy is an important concern, so you should know that your name will be shared with the public unless you request otherwise in item A.8.
1. Patient Name *
1. Patient Name
2. Street Address *
2. Street Address
3. Telephone Number *
3. Telephone Number
5. Date of Birth *
5. Date of Birth
6. Sex *
B. REPORTER INFORMATION
(If different from Patient Information)
1. Reporter Name
1. Reporter Name
2. Street Address
2. Street Address
3. Telephone Number
3. Telephone Number
5. Relation to Patient
C. DRY NEEDLING PROVIDER INFORMATION
1. Dry Needling Provider Name *
1. Dry Needling Provider Name
2. Occupation *
D. DRY NEEDLING FACILITY/CLINIC INFORMATION
2. Street Address *
2. Street Address
3. Telephone Number *
3. Telephone Number
http://
E. DRY NEEDLING ADVERSE EVENT INFORMATION
1. Date of Dry Needling *
1. Date of Dry Needling
2. Outcome(s) of the Dry Needling Adverse Event *
(Check all that apply)
(Include as many details as possible)
4. Date of This Report *
4. Date of This Report

We will contact you if we have additional questions.