BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNK

    MDR report key: 641638 · Received October 12, 2005

    Report

    Report Number
    2132280-2005-00010
    Event Type
    Injury
    Date Received
    October 12, 2005
    Date of Event
    January 1, 2002
    Report Date
    October 12, 2005
    Manufacturer
    SUNRISE MACHINE AND TOOL, INC.
    Product Code
    JXK
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    REC'D MANY ELECTRO SHOCK TREATMENTS. SEVERAL PROBLEMS AFTER ECT INCLUDING LACK OF BALANCE, SEVERE MEMORY LOSS AND INSOMNIA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNK ELECTRO SHOCK JXK SUNRISE MACHINE AND TOOL, INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 46 YR Other| S