BEUDAMED
    FDA Adverse Event Summary report: N

    CATHETER

    MDR report key: 23048 · Received July 29, 1994

    Report

    Report Number
    23048
    Date Received
    July 29, 1994
    Report Date
    July 20, 1994
    Manufacturer
    ARROW
    Product Code
    FEZ
    Report Source
    User Facility report

    Narratives

    Description of Event or Problem · 1

    PART BROKE OFF, SEPARATING FROM TUBING.INVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: INVALID DATA. INVALID DATA - REGARDING MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY.INVALID DATA - REGARDING WHETHER EVENT PRESENTS IMMINENT HAZARD. INVALID DATA - WHETHER DEVICE USED AS LABELED/INTENDED.INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: NO DATA. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CATHETER FEZ ARROW AK15123H

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Invalid Data