BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    FILIFORM

    MDR report key: 440131 · Received January 24, 2003

    Report

    Report Number
    2429473-2003-00005
    Event Type
    Malfunction
    Date Received
    January 24, 2003
    Report Date
    January 23, 2002
    Manufacturer
    RUSCH INC.
    Product Code
    FAX
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTS CONNECTION CAME APART LEAVING FILIFORM INSIDE OF PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FILIFORM UROLOGICAL FAX RUSCH INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN