BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AVANTA

    MDR report key: 2467192 · Received February 16, 2012

    Report

    Report Number
    2467192
    Event Type
    Malfunction
    Date Received
    February 16, 2012
    Date of Event
    February 14, 2012
    Report Date
    February 16, 2012
    Manufacturer
    MEDRAD, INC.
    Product Code
    DXT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MT, US

    Narratives

    Description of Event or Problem · 1

    VENT CAP POPPED OFF WHILE CHANGING CONTRAST.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AVANTA SYRINGE, CONTRAST INJECTION DXT MEDRAD, INC. * 113503

    Patients

    Seq Age Sex Outcome Treatment
    1 *