BEUDAMED
    FDA Adverse Event Death Summary report: N

    PMX MEDICAL G1500

    MDR report key: 506883 · Received December 22, 2003

    Report

    Report Number
    MW1030717
    Event Type
    Death
    Date Received
    December 22, 2003
    Date of Event
    December 13, 2003
    Report Date
    December 19, 2003
    Manufacturer
    PMX MEDICAL, INC.
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    PARAMEDIC

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PMX MEDICAL G1500 IV ADMINISTRATION SET 15ML FPA PMX MEDICAL, INC. G1500 040201A

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR Death