BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    U BY KOTEX CLICK TAMPONS

    MDR report key: 1894738 · Received November 5, 2010

    Report

    Report Number
    3008144662-2010-00026
    Event Type
    Malfunction
    Date Received
    November 5, 2010
    Date of Event
    October 20, 2010
    Report Date
    October 20, 2010
    Manufacturer
    QINGDAO P AND B CORP LTD
    Product Code
    HEB
    PMA / PMN Number
    K091749
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE HISTORY RECORD IN REVIEW. CONSUMER DID NOT RETURN PRODUCT SAMPLES FOR EVALUATION.

    Description of Event or Problem · 1

    CONSUMER STATED SHE TRIED TO REMOVE A TAMPON AND THE TAMPON CAME APART. SHE WAS ABLE TO REMOVE THE REMAINING PIECES ON HER OWN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 U BY KOTEX CLICK TAMPONS HEB - UNSCENTED MENSTRUAL TAMPON HEB QINGDAO P AND B CORP LTD

    Patients

    Seq Age Sex Outcome Treatment
    1 28 YR