BEUDAMED
    FDA Adverse Event Other Summary report: N

    DAVOL

    MDR report key: 141780 · Received January 5, 1998

    Report

    Report Number
    MW1012744
    Event Type
    Other
    Date Received
    January 5, 1998
    Report Date
    January 4, 1998
    Manufacturer
    DAVOL, INC. SUBSIDIARY OF C. R. BARD
    Product Code
    GCY
    Report Source
    Voluntary report
    Reporter Location
    MI, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    DAVOL RELIAVAC DRAIN BALLOON INSIDE OF CONTAINER BROKE 2CM (APPROX) "V-SHAPED" TEAR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DAVOL RELIAVAC DRAIN GCY DAVOL, INC. SUBSIDIARY OF C. R. BARD * *

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR Other