BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CEILING MOUNT

    MDR report key: 107300 · Received July 17, 1997

    Report

    Report Number
    2018492-1997-00006
    Event Type
    Malfunction
    Date Received
    July 17, 1997
    Date of Event
    November 6, 1996
    Report Date
    July 17, 1997
    Manufacturer
    BURTON MEDICAL PRODUCTS CORP.
    Product Code
    FSY
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SD, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    THE PIVOT ASSEMBLY SHEARED AND THE LIGHT FELL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CEILING MOUNT SINGLE CEILING MOUNT FSY BURTON MEDICAL PRODUCTS CORP. 0100140 10 93

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN