BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDITRON

    MDR report key: 133541 · Received November 17, 1997

    Report

    Report Number
    133541
    Event Type
    Injury
    Date Received
    November 17, 1997
    Date of Event
    October 16, 1997
    Report Date
    November 17, 1997
    Manufacturer
    BEI MEDICAL SYSTEMS
    Product Code
    FDF
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    WA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    FOLLOWING REMOVAL OF POLYPS DURING A COLONOSCOPY, THE PT EXPERIENCED A PERFORATED BOWEL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDITRON POWER SOURCE FDF BEI MEDICAL SYSTEMS F1539 *

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Hospitalization