BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LIBBE

    MDR report key: 522644 · Received October 7, 2003

    Report

    Report Number
    522644
    Event Type
    Injury
    Date Received
    October 7, 2003
    Date of Event
    August 19, 2002
    Report Date
    October 7, 2003
    Manufacturer
    TILLER MIND BODY, INC.
    Product Code
    KPL
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIBBE LOWER BOWEL EVACUATION DEVICE KPL TILLER MIND BODY, INC. L9703 *

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Other| R