BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BLADE EXTENDER FOR ADULT LARYNGOSCOPE, 6/PKG

    MDR report key: 1191569 · Received July 23, 2008

    Report

    Report Number
    1519132-2008-00011
    Event Type
    Malfunction
    Date Received
    July 23, 2008
    Date of Event
    April 22, 2008
    Report Date
    July 21, 2008
    Manufacturer
    GYRUS ACMI, INC. - NORWALK
    Product Code
    CCW
    PMA / PMN Number
    EXEMPT
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MA, US
    Reporter Occupation
    RISK MANAGER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BLADE EXTENDER FOR ADULT LARYNGOSCOPE, 6/PKG LARYNGOSCOPE BLADE EXTENDER CCW GYRUS ACMI, INC. - NORWALK LAR-AE 8078021

    Patients

    Seq Age Sex Outcome Treatment
    1 * Required Intervention