BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    V MUELLER

    MDR report key: 1750109 · Received June 29, 2010

    Report

    Report Number
    MW5016607
    Event Type
    Malfunction
    Date Received
    June 29, 2010
    Date of Event
    June 21, 2010
    Report Date
    June 21, 2010
    Manufacturer
    CARE FUSION
    Product Code
    GDG
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NJ, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    BALL HOOK TIP BROKE WHILE IN USE DURING SURGICAL PROCEDURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 V MUELLER BALL HOOK GDG CARE FUSION

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Other