BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MICROMAX SYSTEM NOSEPIECE ATTACHEMENT

    MDR report key: 1111606 · Received August 12, 2008

    Report

    Report Number
    1045834-2008-00081
    Event Type
    Malfunction
    Date Received
    August 12, 2008
    Date of Event
    July 11, 2008
    Report Date
    August 12, 2008
    Manufacturer
    THE ANSPACH EFFORT
    Product Code
    ERL
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    CAME APART.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MICROMAX SYSTEM NOSEPIECE ATTACHEMENT NOSEPIECE ATTACHMENTS ERL THE ANSPACH EFFORT LONG

    Patients

    Seq Age Sex Outcome Treatment
    1 NA