BEUDAMED
    FDA Adverse Event Injury Summary report: N

    INTOXILYZER

    MDR report key: 931835 · Received October 22, 2007

    Report

    Report Number
    MW5004163
    Event Type
    Injury
    Date Received
    October 22, 2007
    Date of Event
    September 10, 2005
    Report Date
    October 3, 2007
    Manufacturer
    MPD, INC. / REGISTERED NAME: CMI, INC.
    Product Code
    DJZ
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OR, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THIS EQUIPMENT AND POLICE ARE DISCRIMINATING AGAINST MY INABILITY TO PROPERLY USE THIS BREATH TEST EQUIPMENT. MY CIVIL RIGHTS ARE BEING VIOLATED, I CONTINUE TO SUFFER PHYSICAL AND MENTAL TRAUMA AND HAVE LOST FRIENDS AND FAMILY. STATE TROOPER DID NOT FOLLOW REQUIRED METHODS OR PROCEDURES TO COMPLY TO STRICT REQUIREMENTS BY MANUFACTURER OF THIS EQUIPMENT SEE TEST RESULTS AND 3-MINUTE TIME LAPSE BEFORE SUBJECT WAS TAKEN (EXHIBIT 1). FORENSIC SVC TECHNICIAN CERTIFIED THE EQUIPMENT WAS ACCURATE ALTHOUGH THE VALUE EXPECTED AND VALUE OBTAINED DEVIATED BY MORE THAN +/- .3 WHICH FAILED THIS ACCURACY CHECK (EXHIBIT 2). THESE BREATH TEST RESULTS HAVE BEEN USED AGAINST ME BY THE FALSIFIED TESTIMONIES OF THIS TECH AND TROOPER. HORRID DISCRIMINATION. I DID NOT RECEIVE CERT. TO ACCURACY OF EQUIPMENT. THERE WAS MORE THAN ONE BREATH TEST TAKEN BUT WAS NEVER PRODUCED. OFFICER CLAIMED I MET REQUIREMENTS. TWO DIFFERENT POLICE OFFICERS SIGN IMPLIED CONSENT FORM, SEE EXHIBIT 1 & 2 TO ONE BREATH TEST SUPPLIED - EXHIBIT 3. NEITHER OF THESE OFFICERS TOOK ANY GIVEN BREATH TEST. THE OFFICER WHOM TRANSPORTED ME GAVE ME THESE TESTS. HE WAS YOUNGER LOOKING WITH LIGHT COLORED - HAIR. THE REQUIREMENTS TO COMPLIANCE WERE NOT MET.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INTOXILYZER ALCOHOL BREATH TEST SYSTEM/MEDICAL CLASS 1 DEVICE DJZ MPD, INC. / REGISTERED NAME: CMI, INC. 5000
    2 INTOXILYZER ALCOHOL BREATH TEST SYSTEM/MEDICAL CLASS 1 DEVICE DJZ MPD, INC. / REGISTERED NAME: CMI, INC. 5000

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Other