BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 575546 · Received February 7, 2005

    Report

    Report Number
    1216146-2005-00001
    Event Type
    Malfunction
    Date Received
    February 7, 2005
    Date of Event
    December 22, 2004
    Report Date
    January 10, 2005
    Manufacturer
    J. H. EMERSON CO.
    Product Code
    JCX
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    EVENT DESC: PT WAS ON 40CM SUCTION AND PUMP SIMPLY SHUT OFF. THE TOP OF THE PUMP WAS HOY TO THE TOUCH. DEVICE USAGE PROBLEM DEVICE FAILED (E.G. BROKE, COULDN'T GET IT TO WORK OR STOPPED WORKING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * * JCX J. H. EMERSON CO. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other