BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VORTEX

    MDR report key: 4123119 · Received August 14, 2014

    Report

    Report Number
    4123119
    Event Type
    Malfunction
    Date Received
    August 14, 2014
    Date of Event
    August 13, 2014
    Report Date
    August 14, 2014
    Manufacturer
    ANGIODYNAMICS, INC.
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MI, US

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    488068 VORTEX PORT, VASCULAR ACCESS LJT ANGIODYNAMICS, INC. H787LVTX52130 4759868

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR