BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    2PC VSYS/PRT/LOCKS 4NDL LW PFL

    MDR report key: 971141 · Received December 26, 2007

    Report

    Report Number
    1219930-2007-00880
    Event Type
    Malfunction
    Date Received
    December 26, 2007
    Date of Event
    November 12, 2007
    Report Date
    November 14, 2007
    Manufacturer
    NORTH HAVEN - USS
    Product Code
    LJT
    PMA / PMN Number
    K952748
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    SEX: UNK. PROCEDURE: UNK. ACCORDING TO THE REPORTER: THE CATHETER BROKE PRIOR TO BEING IMPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 2PC VSYS/PRT/LOCKS 4NDL LW PFL NONE LJT NORTH HAVEN - USS UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK YR