BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ANEURYSM CLIP

    MDR report key: 2805653 · Received October 16, 2012

    Report

    Report Number
    1045834-2012-00026
    Event Type
    Malfunction
    Date Received
    October 16, 2012
    Date of Event
    September 17, 2012
    Report Date
    September 18, 2012
    Manufacturer
    PETER LAZIC GMBH
    Product Code
    HCH
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    MN, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    PRODUCT IS CURRENTLY ON HOLD PENDING AN INVESTIGATION.

    Description of Event or Problem · 1

    ANEURYSM CLIP CATALOG NUMBER 45.650 WAS LABELED AS 45.660.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ANEURYSM CLIP L-ANEURYSM CLIP HCH PETER LAZIC GMBH L-ANEURYSM CLIP

    Patients

    Seq Age Sex Outcome Treatment
    1