BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ETHILON BLU 100CM 1 KP-3 CONV

    MDR report key: 3876527 · Received June 17, 2014

    Report

    Report Number
    2210968-2014-04168
    Event Type
    Malfunction
    Date Received
    June 17, 2014
    Date of Event
    March 13, 2014
    Manufacturer
    ETHICON INC.
    Product Code
    GAR
    PMA / PMN Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    OTHER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    356684 ETHILON BLU 100CM 1 KP-3 CONV SUTURE, NONABSORBABLE, SYNTHETIC GAR ETHICON INC. GL5BWPE

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown Required Intervention