BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SILHOUETTE

    MDR report key: 432367 · Received December 6, 2002

    Report

    Report Number
    8021545-2002-00237
    Event Type
    Malfunction
    Date Received
    December 6, 2002
    Date of Event
    June 28, 2002
    Report Date
    December 5, 2002
    Manufacturer
    MAERSK MEDICAL A/S
    Product Code
    FPA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    IN 2002 THE END-USER CALLED MEDTRONIC MINIMED, USA AND STATED THAT THE INFUSION SET WAS DEFECTIVE. ON 11/22/2002 MAERSK MEDICAL A/S RECEIVED THE COMPLAINT AND 1 USED TUBING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SILHOUETTE SUBCUTANEOUS INFUSION SET FPA MAERSK MEDICAL A/S 23" UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other SYRINGE/RESERVOIR| INSULIN| INFUSION PUMP