BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACIST

    MDR report key: 504826 · Received December 27, 2003

    Report

    Report Number
    MW1030656
    Event Type
    Malfunction
    Date Received
    December 27, 2003
    Date of Event
    December 26, 2003
    Report Date
    December 27, 2003
    Manufacturer
    ACIST MEDICAL SYSTEMS
    Product Code
    IZQ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OR, US
    Reporter Occupation
    RADIOLOGIC TECHNOLOGIST

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACIST CONTRAST INJECTOR IZQ ACIST MEDICAL SYSTEMS CP101 (DISPLAY) *

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR Other