BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SYMMETRY DECKER

    MDR report key: 14731300 · Received June 17, 2022

    Report

    Report Number
    14731300
    Event Type
    Malfunction
    Date Received
    June 17, 2022
    Date of Event
    May 25, 2022
    Report Date
    June 7, 2022
    Manufacturer
    SYMMETRY SURGICAL INC.
    Product Code
    HAE
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA
    Reporter Occupation
    RISK MANAGER
    Health Professional
    N

    Narratives

    Description of Event or Problem · 0

    DOCTOR WHILE USING THE MICRO PITUITARY RONGEUR. THE INSTRUMENT BROKE AT THE TIP. INSTRUMENT SEQUESTERED AND CHECKED FOR COMPLETENESS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    203118 SYMMETRY DECKER RONGEUR, MANUAL HAE SYMMETRY SURGICAL INC. 53-4002

    Patients

    Seq Age Sex Outcome Treatment
    1 20805 DA Unknown