BEUDAMED
    FDA Adverse Event Injury Summary report: N

    *

    MDR report key: 568629 · Received January 28, 2005

    Report

    Report Number
    2031002-2005-00001
    Event Type
    Injury
    Date Received
    January 28, 2005
    Date of Event
    December 29, 2004
    Report Date
    January 27, 2005
    Manufacturer
    HANCOCK JAFFE LABORATORIES, INC.
    Product Code
    MDQ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * BOVINE MESENTERIC VEIN BIOPROSTHEISIS FOR VASCULAR ACCESS MDQ HANCOCK JAFFE LABORATORIES, INC. HJL016-40-N SB011040

    Patients

    Seq Age Sex Outcome Treatment
    1 * Hospitalization| L| R