BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VISITEC

    MDR report key: 4371333 · Received November 12, 2014

    Report

    Report Number
    4371333
    Event Type
    Malfunction
    Date Received
    November 12, 2014
    Date of Event
    October 29, 2014
    Report Date
    November 12, 2014
    Manufacturer
    BEAVER-VISITEC INTERNATIONAL, INC.
    Product Code
    HMX
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MI, US

    Narratives

    Description of Event or Problem · 1

    DISPOSABLE 30 GAUGE CANNULA WAS RELEASED FROM SYRINGE WHEN INJECTED BY THE DOCTOR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    729876 VISITEC CANNULA, INJECTION HMX BEAVER-VISITEC INTERNATIONAL, INC. 581273 *

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR