BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    IQ MS WIRE

    MDR report key: 796638 · Received December 6, 2006

    Report

    Report Number
    796638
    Event Type
    Malfunction
    Date Received
    December 6, 2006
    Date of Event
    December 4, 2006
    Report Date
    December 6, 2006
    Manufacturer
    BOSTON SCIENTIFIC CORPORATION
    Product Code
    DQX
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    WHEN ATTEMPTING TO REMOVE THE GUIDEWIRE, THE TIP BROKE OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IQ MS WIRE GUIDEWIRE DQX BOSTON SCIENTIFIC CORPORATION * 9003423

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR CARDIAC DRUGS