BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    5202730-2027S1B SER 1 SMOKE EVAC

    MDR report key: 457486 · Received April 24, 2003

    Report

    Report Number
    1213643-2003-00022
    Event Type
    Malfunction
    Date Received
    April 24, 2003
    Date of Event
    March 25, 2003
    Report Date
    March 25, 2003
    Manufacturer
    DAVOL SURGICAL INNOVATIONS (JUAREZ/MX)
    Product Code
    GCJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DESCRIBE EVENT OR PROBLEM: SMOKEVAC BUTTON STICKING - 1 EACH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 5202730-2027S1B SER 1 SMOKE EVAC 350101209-AHS TUBE SETS GCJ DAVOL SURGICAL INNOVATIONS (JUAREZ/MX) * 41KLN008

    Patients

    Seq Age Sex Outcome Treatment
    1 *