BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BASIC CONFIGURATION MODEL 1105

    MDR report key: 2890638 · Received November 21, 2012

    Report

    Report Number
    1831750-2012-12173
    Event Type
    Malfunction
    Date Received
    November 21, 2012
    Date of Event
    October 12, 2012
    Report Date
    October 26, 2012
    Manufacturer
    STRYKER MEDICAL
    Product Code
    FPO
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    IV POLE. MFR'S INVESTIGATION IS ONGOING. IF ADD'L INFO IS REC'D, A F/U REPORT MAY BE SUBMITTED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE IV POLE HAD MALFUNCTIONED. NO PT INVOLVEMENT OR ADVERSE CONSEQUENCES WERE REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BASIC CONFIGURATION MODEL 1105 HOSPITAL WHEELED STRETCHER FPO STRYKER MEDICAL 1105 NA

    Patients

    Seq Age Sex Outcome Treatment
    1