BEUDAMED
    FDA Adverse Event Other Summary report: N

    HUMAPEN ERGO, TEAL/CLEAR

    MDR report key: 504565 · Received December 12, 2003

    Report

    Report Number
    1819470-2003-00046
    Event Type
    Other
    Date Received
    December 12, 2003
    Report Date
    November 17, 2003
    Manufacturer
    ELI LILLY AND CO.
    Product Code
    KZE
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HUMAPEN ERGO, TEAL/CLEAR PEN INJECTOR KZE ELI LILLY AND CO. MS8929 270203

    Patients

    Seq Age Sex Outcome Treatment
    1 39 YR Other