BEUDAMED
    FDA Adverse Event Death Summary report: N

    BLACKMAX SYSTEM MOTOR (DEVICE #1)

    MDR report key: 421614 · Received October 8, 2002

    Report

    Report Number
    1045834-2002-00046
    Event Type
    Death
    Date Received
    October 8, 2002
    Date of Event
    September 23, 2002
    Report Date
    October 4, 2002
    Manufacturer
    THE ANSPACH EFFORT INC.
    Product Code
    HBB
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    MOTOR SEEMS TO HAVE SOME LACK IN POWER. SPEED REDUCER WAS BEING USED WITH MOTOR AT THE TIME. REPORTER STATED THAT PT'S DEATH WAS NOT CAUSED BY ANSPACH EQUIPMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BLACKMAX SYSTEM MOTOR (DEVICE #1) MOTOR HBB THE ANSPACH EFFORT INC. BLACKMAX-N 30932C

    Patients

    Seq Age Sex Outcome Treatment
    1 * Death