BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    JET CIRCUIT

    MDR report key: 556352 · Received August 25, 2004

    Report

    Report Number
    MW1033056
    Event Type
    Malfunction
    Date Received
    August 25, 2004
    Date of Event
    August 23, 2004
    Report Date
    August 24, 2004
    Manufacturer
    BUNNELL INC.
    Product Code
    BZO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    TUBING WAS DETACHED FROM PRODUCT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JET CIRCUIT JET CIRCUIT BZO BUNNELL INC. * 4D0148

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other