BEUDAMED
    FDA Adverse Event Other Summary report: N

    RELIAVAC, 400 CC

    MDR report key: 29270 · Received January 11, 1996

    Report

    Report Number
    MW1008079
    Event Type
    Other
    Date Received
    January 11, 1996
    Date of Event
    December 1, 1995
    Manufacturer
    DAVOL, INC.
    Product Code
    GCY
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MI, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    POST LARYNGECTOMY SURGERY. DRAIN NOT FUNCTIONING. BLOCKED DRAINAGE SYSTEM. RPTR REQUESTS MFR'S REPORT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RELIAVAC, 400 CC DRAIN GCY DAVOL, INC. 0020800

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other