BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SHAMPAINE

    MDR report key: 5404966 · Received September 8, 2003

    Report

    Report Number
    3019090-2003-00003
    Event Type
    Malfunction
    Date Received
    September 8, 2003
    Date of Event
    July 17, 2003
    Report Date
    September 2, 2003
    Manufacturer
    GETINGE USA, INC
    Product Code
    FQO
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SHAMPAINE SURGICAL TABLE FQO GETINGE USA, INC 5100B

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR Other