BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SHOPKO

    MDR report key: 4122378 · Received September 18, 2014

    Report

    Report Number
    1038758-2014-00026
    Event Type
    Injury
    Date Received
    September 18, 2014
    Report Date
    September 17, 2014
    Manufacturer
    ASO LLC
    Product Code
    KGX
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UT, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    ON (B)(6) 2014 - PRODUCT CAUSED RASH, TORE SKIN AND LEFT A SCAR AROUND AREA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    579153 SHOPKO ADHESIVE BANDAGE KGX ASO LLC

    Patients

    Seq Age Sex Outcome Treatment
    1 Other