BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ULTRA FOUR-WAY STOPCOCK W/SWIVEL MALE LUER LOCK

    MDR report key: 2071613 · Received April 20, 2011

    Report

    Report Number
    2183502-2011-00155
    Event Type
    Injury
    Date Received
    April 20, 2011
    Manufacturer
    SMITHS MEDICAL ASD, INC.
    Product Code
    FMG
    PMA / PMN Number
    K820355
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    CUSTOMER HAS NOT YET RETURNED THE DEVICE TO THE MANUFACTURER FOR DEVICE EVALUATION. WHEN AND IF THE DEVICE BECOMES AVAILABLE AND IS RETURNED AND EVALUATED THE MANUFACTURER WILL FILE A FOLLOW-UP REPORT DETAILING THE RESULTS OF THE EVALUATION.

    Description of Event or Problem · 1

    .

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ULTRA FOUR-WAY STOPCOCK W/SWIVEL MALE LUER LOCK STOPCOCKS AND MANIFOLDS FMG SMITHS MEDICAL ASD, INC. NA 1798973

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK