BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ADAP 2000

    MDR report key: 618938 · Received August 10, 2004

    Report

    Report Number
    1056553-2004-00001
    Event Type
    Malfunction
    Date Received
    August 10, 2004
    Date of Event
    July 21, 2004
    Report Date
    August 10, 2004
    Manufacturer
    REMINGTON MEDICAL, INC.
    Product Code
    DSA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    CUSTOMER STATED THAT WHEN THEY CONNECTED OUR BLACK PLUG INTO THE MEDTRONIC 5388 THE BLACK PLUG BROKE - ALSO STATED WHEN THEY TRIED TO REMOVE CO'S PLUG FROM THE MEDTRONIC DEVICE THE PLUG BROKE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ADAP 2000 DISPOSABLE ADAPTER DSA REMINGTON MEDICAL, INC. ADAP 2000 033505

    Patients

    Seq Age Sex Outcome Treatment
    1 *