BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LAPAROSCOPIC IRRIGATOR

    MDR report key: 508843 · Received October 17, 2003

    Report

    Report Number
    508843
    Event Type
    Malfunction
    Date Received
    October 17, 2003
    Date of Event
    September 1, 2003
    Report Date
    September 1, 2003
    Manufacturer
    DAVOL, INC.
    Product Code
    KQT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LAPAROSCOPIC IRRIGATOR LAPAROSCOPIC IRRIGATOR KQT DAVOL, INC. 00268880 41ANN090

    Patients

    Seq Age Sex Outcome Treatment
    1 *