BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COOK

    MDR report key: 506293 · Received October 17, 2003

    Report

    Report Number
    506293
    Event Type
    Malfunction
    Date Received
    October 17, 2003
    Date of Event
    January 1, 2003
    Report Date
    October 1, 2003
    Manufacturer
    COOK VASCULAR, INC.
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COOK ANTIBIOTIC COATED TRIPLE LUMEN CATHETER LJT COOK VASCULAR, INC. 7 FR 20 CM *

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Other