BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BLACKMAX SYSTEM MOTOR

    MDR report key: 514191 · Received January 22, 2004

    Report

    Report Number
    1045834-2004-00054
    Event Type
    Malfunction
    Date Received
    January 22, 2004
    Date of Event
    December 12, 2003
    Report Date
    January 19, 2004
    Manufacturer
    THE ANSPACH EFFORT, INC.
    Product Code
    HBB
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    CUSTOMER STATED MOTOR SEEMED TO RUN INTERMITTENTLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BLACKMAX SYSTEM MOTOR MOTOR HBB THE ANSPACH EFFORT, INC. BLACKMAX-N A65124A

    Patients

    Seq Age Sex Outcome Treatment
    1 *