BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CROSSER

    MDR report key: 3192331 · Received June 26, 2013

    Report

    Report Number
    3192331
    Event Type
    Malfunction
    Date Received
    June 26, 2013
    Date of Event
    June 3, 2013
    Report Date
    June 26, 2013
    Manufacturer
    BARD PERIPHERAL VASCULAR, INC. ,
    Product Code
    DQY
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    RI, US

    Narratives

    Description of Event or Problem · 1

    DURING ANGIOGRAPHIC PROCEDURE CATHETER TIP WAS BROKEN OFF IN PATIENT.DEVICE #1IS THIS A LABORATORY DEVICE OR LABORATORY TEST?NO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    291406 CROSSER CATHETER DQY BARD PERIPHERAL VASCULAR, INC. , CRUS6A FCXC10011

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR