BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PRESIDIO

    MDR report key: 1162759 · Received September 15, 2008

    Report

    Report Number
    MW5008315
    Event Type
    Malfunction
    Date Received
    September 15, 2008
    Date of Event
    September 3, 2008
    Report Date
    September 15, 2008
    Manufacturer
    MICRUS ENDOVASCULAR
    Product Code
    HCG
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OH, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    COIL DELIVERY WIRE BROKE DURING MANIPULATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRESIDIO ANEURYSM MICROCOIL HCG MICRUS ENDOVASCULAR PC4181846-30 32985

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR