BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GAYMAR INDUSTRIES, INC.

    MDR report key: 465027 · Received June 5, 2003

    Report

    Report Number
    MW1028641
    Event Type
    Malfunction
    Date Received
    June 5, 2003
    Date of Event
    October 7, 2002
    Report Date
    November 8, 2002
    Manufacturer
    GAYMAR
    Product Code
    FNM
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NE, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    MATTRESS PUMP MALFUNCTION. PUMP DISCOVERED SPARKING WITH YELLOW LIQUID NOTED IN AND AROUND PUMP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GAYMAR INDUSTRIES, INC. MATTRESS PUMP FNM GAYMAR * *

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Other