BEUDAMED
    FDA Adverse Event Other Summary report: N

    CIRCON ACMI

    MDR report key: 1250466 · Received December 2, 2008

    Report

    Report Number
    1250466
    Event Type
    Other
    Date Received
    December 2, 2008
    Date of Event
    November 10, 2008
    Report Date
    November 26, 2008
    Manufacturer
    CIRCON ACMI
    Product Code
    CCW
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NH, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    THE PLASTIC GUARD WHICH IS SNAPPED ONTO THE BLADE AND SCOPE CAME OFF AND STAYED IN THE PT'S THROAT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CIRCON ACMI PLASTIC GUARD FOR BLADE CCW CIRCON ACMI LAR-AE 7211008

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR Other