BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    REBAR MICRO CATHETER

    MDR report key: 505825 · Received December 19, 2003

    Report

    Report Number
    2029214-2003-00051
    Event Type
    Malfunction
    Date Received
    December 19, 2003
    Date of Event
    November 25, 2003
    Report Date
    November 26, 2003
    Manufacturer
    MICRO THERAPEUTICS, INC.
    Product Code
    KRA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 REBAR MICRO CATHETER NEURO MICRO CATHETER KRA MICRO THERAPEUTICS, INC. 105-5080-153 377901

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN ONYX LIQUID EMBOLIC SYSTEM.