BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MEDICON

    MDR report key: 979777 · Received June 5, 2006

    Report

    Report Number
    8010099-2006-00001
    Event Type
    Malfunction
    Date Received
    June 5, 2006
    Date of Event
    April 13, 2006
    Report Date
    May 24, 2006
    Manufacturer
    MEDICON, E.G.
    Product Code
    FHQ
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    RISK MANAGER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDICON LAPAROSCOPIC NEEDLE HOLDER FOR MIS FHQ MEDICON, E.G. 91. 20. 38 24 2B

    Patients

    Seq Age Sex Outcome Treatment
    1 * Required Intervention