BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    EASYTRAK MIDDLEWEIGHT GUIDE WIRE

    MDR report key: 1042168 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-34474
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    March 11, 2008
    Report Date
    March 12, 2008
    Manufacturer
    EXTERNAL MANUFACTURER
    Product Code
    LWP
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EASYTRAK MIDDLEWEIGHT GUIDE WIRE GUIDE WIRE LWP EXTERNAL MANUFACTURER 6720 6110351

    Patients

    Seq Age Sex Outcome Treatment
    1 Other THE DEVICE 6720 WAS USED DURING THE EVENT.| THE DEVICE H140/109307 WAS IMPLANTED| THE DEVICE 4555/163533 WAS IMPLANTED