BEUDAMED
    FDA Adverse Event Other Summary report: N

    SMARTPLUG

    MDR report key: 507360 · Received December 19, 2003

    Report

    Report Number
    2031959-2003-00047
    Event Type
    Other
    Date Received
    December 19, 2003
    Report Date
    December 18, 2003
    Manufacturer
    MEDENNIUM, INC.
    Product Code
    LZU
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SMARTPLUG PUNCTUM PLUG LZU MEDENNIUM, INC. MODEL 500 UNK, NI

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other| R