BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MAILMAN SUPER SUPPORT

    MDR report key: 2946163 · Received January 30, 2013

    Report

    Report Number
    2946163
    Event Type
    Malfunction
    Date Received
    January 30, 2013
    Date of Event
    January 22, 2013
    Report Date
    January 30, 2013
    Manufacturer
    BOSTON SCIENTIFIC
    Product Code
    DQX
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    40757 MAILMAN SUPER SUPPORT WIRE, GUIDE, CATHETER DQX BOSTON SCIENTIFIC 12136-01J *

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR