BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MIZUHO OSI

    MDR report key: 1490760 · Received September 30, 2009

    Report

    Report Number
    1490760
    Event Type
    Malfunction
    Date Received
    September 30, 2009
    Date of Event
    September 22, 2009
    Report Date
    September 25, 2009
    Manufacturer
    MIZUHO OSI
    Product Code
    FQO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    SC, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PIECE BROKE ON HANA TABLE AND PT. FELL TO FLOOR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MIZUHO OSI HANA SURGERY TABLE FQO MIZUHO OSI 6875

    Patients

    Seq Age Sex Outcome Treatment
    1 Other