BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    FILIFORM STRAIGHT TIP

    MDR report key: 541654 · Received March 29, 2004

    Report

    Report Number
    2429473-2004-00040
    Event Type
    Malfunction
    Date Received
    March 29, 2004
    Report Date
    March 26, 2004
    Manufacturer
    RUSCH INC.
    Product Code
    FBW
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    DC, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTS DEVICE BROKE INSIDE OF PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FILIFORM STRAIGHT TIP UROLOGICAL FBW RUSCH INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN