BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ADAPTOR, HOLDER, SYRINGE

    MDR report key: 7999925 · Received October 23, 2018

    Report

    Report Number
    MW5080791
    Event Type
    Malfunction
    Date Received
    October 23, 2018
    Date of Event
    October 17, 2018
    Report Date
    October 18, 2018
    Manufacturer
    ABBVIE MEDICAL DEVICE CENTER
    Product Code
    IQG
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    PT SAYS THAT GRAY NEEDLE COVER DOES NOT LOOK RIGHT ON HIS CURRENT PEN. "EVENT RESOLVED, PROVIDED MFR'S PHONE."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    836187 ADAPTOR, HOLDER, SYRINGE ADAPTOR, HOLDER, SYRINGE IQG ABBVIE MEDICAL DEVICE CENTER

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR