BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    FILIFORM

    MDR report key: 477907 · Received August 11, 2003

    Report

    Report Number
    2429473-2003-00086
    Event Type
    Malfunction
    Date Received
    August 11, 2003
    Report Date
    July 28, 2003
    Manufacturer
    RUSCH, INC.
    Product Code
    FAX
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTS FILIFORM DISLODGED IN 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