BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BLACKMAX SYSTEM NOSEPIECE ATTACHMENTS

    MDR report key: 520711 · Received February 5, 2004

    Report

    Report Number
    1045834-2004-00151
    Event Type
    Malfunction
    Date Received
    February 5, 2004
    Date of Event
    January 7, 2004
    Report Date
    February 5, 2004
    Manufacturer
    THE ANSPACH EFFORT, INC.
    Product Code
    HBB
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NH, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    CUSTOMER STATED A CUTTER WAS STUCK IN THE ATTACHMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BLACKMAX SYSTEM NOSEPIECE ATTACHMENTS ATTACHMENT HBB THE ANSPACH EFFORT, INC. B-BLUE-S *

    Patients

    Seq Age Sex Outcome Treatment
    1 *