BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BLACKMAX SYSTEM MOTORS

    MDR report key: 1063536 · Received June 19, 2008

    Report

    Report Number
    1045834-2008-00043
    Event Type
    Malfunction
    Date Received
    June 19, 2008
    Date of Event
    May 30, 2008
    Report Date
    June 19, 2008
    Manufacturer
    THE ANSPACH EFFORT, INC.
    Product Code
    HBB
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    HOSE RUPTURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BLACKMAX SYSTEM MOTORS MOTORS HBB THE ANSPACH EFFORT, INC. BLACKMAX-N

    Patients

    Seq Age Sex Outcome Treatment
    1 NA