BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PROTECTIV JELCO

    MDR report key: 4093865 · Received September 9, 2014

    Report

    Report Number
    4093865
    Event Type
    Malfunction
    Date Received
    September 9, 2014
    Date of Event
    April 22, 2014
    Report Date
    September 9, 2014
    Manufacturer
    SMITHS MEDICAL INC.
    Product Code
    FOZ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    FL, US

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    551707 PROTECTIV JELCO INTRAVENOUS CATHETER, SHORT TERM FOZ SMITHS MEDICAL INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR