BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EXTRACORPOREAL FILTER

    MDR report key: 21251 · Received January 21, 1995

    Report

    Report Number
    1036499-1995-00003
    Event Type
    Injury
    Date Received
    January 21, 1995
    Manufacturer
    PALL BIOMEDICAL PRODUCTS COMPANY
    Product Code
    LLB
    Report Source
    Distributor report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ATTACHED TO THE ORIGINAL IS THE PERFUSION RECORD RECEIVED FROM THE PALL REGIONAL REPRESENTATIVE WHO, IN TURN RECEIVED IT FROM THE HOSPITAL. THE EVENT DESCRIPTION WAS NOT WRITTEN OUT IADEQUATE FORM FOR DATA ENTRY.(SEE ORIGINAL/HARD COPY).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EXTRACORPOREAL FILTER PROFUSION DEVICE LLB PALL BIOMEDICAL PRODUCTS COMPANY LG-6

    Patients

    Seq Age Sex Outcome Treatment
    1 * Life Threatening PRODUCTS, INC.| MODEL LG-6 EXTRACORPOREAL FILTER-PALL BIOMEDICAL