BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BRAVO

    MDR report key: 1133633 · Received August 20, 2008

    Report

    Report Number
    2032545-2008-05109
    Event Type
    Malfunction
    Date Received
    August 20, 2008
    Date of Event
    July 22, 2008
    Report Date
    July 22, 2008
    Manufacturer
    ARIZONA DEVICE MANUFACTURING
    Product Code
    FFT
    PMA / PMN Number
    K002028
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    FINAL DEVICE ANALYSIS WAS NOT AVAILABLE AT THE TIME OF THIS REPORT. A FOLLOW-UP MEDWATCH REPORT WILL BE SENT WHEN THE ANALYSIS IS COMPLETE AND/OR WHEN ADDITIONAL INFORMATION IS RECEIVED FROM THE HCP. THE DEVICE IS INCLUDED IN THE BRAVO PH CAPSULE AND DELIVERY SYSTEM (5-PACK) AND (SINGLE-PACK) FIELD ACTION - FAILURE TO DETACH, PHYSICIAN COMMUNICATION (03-DECEMBER-2007).

    Description of Event or Problem · 1

    SEE ALSO MANUFACTURER REPORT 2032545200805110. IT WAS REPORTED THAT WHILE PLACING A BRAVO PH MONITOR, THE CAPSULE ATTACHED TO THE PATIENT'S ESOPHAGUS BUT WOULD NOT DEPLOY FROM THE DELIVERY SYSTEM. THE HANDPIECE BROKE DURING THE PROCEDURE. THIS WAS THE FIRST CAPSULE ATTEMPTED FOR THIS PATIENT. NO SERIOUS INJURY TO THE PATIENT WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BRAVO FFT ARIZONA DEVICE MANUFACTURING 9012B1001 Q233402

    Patients

    Seq Age Sex Outcome Treatment
    1