BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    V. MUELLER

    MDR report key: 1842648 · Received September 20, 2010

    Report

    Report Number
    MW5017506
    Event Type
    Malfunction
    Date Received
    September 20, 2010
    Date of Event
    July 16, 2010
    Report Date
    August 31, 2010
    Product Code
    KCH
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NJ, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    OTHER SERIOUS OUTCOME. DIAGNOSIS OR REASON FOR USE: ANGIOEDEMA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 V. MUELLER CRICOID/TRACHEAL HOOKS KCH BE 395

    Patients

    Seq Age Sex Outcome Treatment
    1 44 YR Other