BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    RELIAVAC 100 MEDIUM SUCTION 100 CC

    MDR report key: 2042567 · Received March 29, 2011

    Report

    Report Number
    2042567
    Event Type
    Malfunction
    Date Received
    March 29, 2011
    Report Date
    March 29, 2011
    Manufacturer
    BARD
    Product Code
    GCY
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    FL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    THE MD STATES THIS IS THE SECOND TIME DURING A FOLLOW-UP VISIT IN THE OFFICE THAT THE WOUND EVACUATOR HAS LOST THE GREEN PIECE. THE SURGEON BROUGHT THE DEVICE TO THE HOSPITAL TO SHOW WHICH PIECE. THIS DEVICE HAS BEEN MAILED TO THE COMPANY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RELIAVAC 100 MEDIUM SUCTION 100 CC CLOSED WOUND SUCTION EVACUATOR GCY BARD 0070850 *

    Patients

    Seq Age Sex Outcome Treatment
    1 *