BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 105880 · Received July 16, 1997

    Report

    Report Number
    MW1011698
    Event Type
    Malfunction
    Date Received
    July 16, 1997
    Date of Event
    May 22, 1997
    Report Date
    July 7, 1997
    Manufacturer
    KARL STORZ ENDOSCOPY-AMERICA, INC.
    Product Code
    FFZ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    POWER CORD (CABLE) POPPED AND FLASHED, THEN SPLIT IN HALF AT THE JUNCTURE TO PLASTIC CONNECTOR. NO INJURY TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * RESECTOSCOPE ELECTRODE CABLE FFZ KARL STORZ ENDOSCOPY-AMERICA, INC. #279 *

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Other