BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DGW .035 MC J3M 150CM T H AMP

    MDR report key: 906441 · Received August 19, 2004

    Report

    Report Number
    1016427-2004-00091
    Event Type
    Malfunction
    Date Received
    August 19, 2004
    Date of Event
    July 2, 2004
    Report Date
    August 19, 2004
    Manufacturer
    CORDIS CORPORATION (MIAMI)
    Product Code
    DQX
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    OTHER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DGW .035 MC J3M 150CM T H AMP CARDIOLOGY WIRES & METALS DQX CORDIS CORPORATION (MIAMI) NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 YR