BEUDAMED
    FDA Adverse Event Other Summary report: N

    SYNCHROMED EL

    MDR report key: 505851 · Received December 16, 2003

    Report

    Report Number
    6000030-2003-01176
    Event Type
    Other
    Date Received
    December 16, 2003
    Report Date
    November 3, 2003
    Manufacturer
    RICE CREEK MFR
    Product Code
    LKK
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SYNCHROMED EL PUMP LKK RICE CREEK MFR 862718 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 14 YR Other CATHETER MODEL 8711 LOT# J11155R37 IMPLANTED: 2002| EXPLANTED: UNK.