BEUDAMED
    FDA Adverse Event Other Summary report: N

    XA-2811 CLICK-STYLE REGULATOR

    MDR report key: 492621 · Received October 22, 2003

    Report

    Report Number
    1526809-2003-00009
    Event Type
    Other
    Date Received
    October 22, 2003
    Date of Event
    June 11, 2002
    Report Date
    October 22, 2003
    Manufacturer
    WESTERN/SCOTT FETZER CO.
    Product Code
    CAN
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    WESTERN BECAME AWARE OF AN INCIDENT THAT OCCURRED IN 2002 INVOLVING A WESTERN XA-2811 REGULATOR. THE OUTCOME OF THE EVENT WAS A FIRE THAT RESULTED IN PROPERTY DAMAGE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 XA-2811 CLICK-STYLE REGULATOR PRESSURE REGULATOR CAN WESTERN/SCOTT FETZER CO. XA-2811 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other