BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BLACKMAX SYSTEM MOTORS

    MDR report key: 1150888 · Received September 2, 2008

    Report

    Report Number
    1045834-2008-00089
    Event Type
    Malfunction
    Date Received
    September 2, 2008
    Date of Event
    August 15, 2008
    Report Date
    September 2, 2008
    Manufacturer
    THE ANSPACH EFFORT
    Product Code
    HBB
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE REPORTED HOSE DAMAGE WAS OBSERVED TO ACTUALLY BE A HOSE RUPTURE.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 NA