BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 4226419 · Received October 31, 2014

    Report

    Report Number
    4226419
    Event Type
    Malfunction
    Date Received
    October 31, 2014
    Date of Event
    October 29, 2014
    Report Date
    October 31, 2014
    Manufacturer
    APPLIED MEDICAL RESOURCES CORP.
    Product Code
    GCJ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MO, US
    Reporter Occupation
    RISK MANAGER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    699498 * LAPAROSCOPE, GENERAL, PLASTIC GCJ APPLIED MEDICAL RESOURCES CORP. COR47 1224710

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR