BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DONJOY PAIN BUSTER

    MDR report key: 997179 · Received February 8, 2008

    Report

    Report Number
    MW5005371
    Event Type
    Malfunction
    Date Received
    February 8, 2008
    Date of Event
    January 25, 2008
    Report Date
    February 8, 2008
    Manufacturer
    DONJOY DJO, LLC
    Product Code
    MEB
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DON JOY PAIN MANAGEMENT PUMP FAILED TO DELIVER ANESTHETIC. DEVICE HOLDS 120CC TO BE DELIVERED OVER 48 HOURS. PRODUCT REF-11-1453 LOT #60883811. EXP. DATE: 08/2008.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DONJOY PAIN BUSTER NONE MEB DONJOY DJO, LLC 11-1453 60883811

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR