BEUDAMED
    FDA Adverse Event Other Summary report: N

    MILTEX

    MDR report key: 119584 · Received September 11, 1997

    Report

    Report Number
    2431021-1997-00009
    Event Type
    Other
    Date Received
    September 11, 1997
    Date of Event
    September 3, 1997
    Report Date
    September 11, 1997
    Manufacturer
    MILTEX INSTRUMENT CO.
    Product Code
    KYZ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    SYRINGE CAME APART WHILE IN USE, LACERATING THE PATIENTS EARDRUM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MILTEX EAR SYRINGE, 4 OZ W/SHIELD KYZ MILTEX INSTRUMENT CO. 19-385 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR Required Intervention