BEUDAMED
    FDA Adverse Event Injury Summary report: N

    STARTER KIT, SIZE 3, 1213

    MDR report key: 112405 · Received August 11, 1997

    Report

    Report Number
    1224675-1997-00042
    Event Type
    Injury
    Date Received
    August 11, 1997
    Date of Event
    July 1, 1997
    Report Date
    July 25, 1997
    Manufacturer
    UROMED CORP.
    Product Code
    MNG
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NE, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    PT WAS DIAGNOSED WITH A DEVICE MIGRATION AFTER AN ULTRASOUND WAS PERFORMED ON 7/23/97.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 STARTER KIT, SIZE 3, 1213 RELIANCE MNG UROMED CORP. SIZE 3 0000000008

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR Required Intervention