BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MIDMARK

    MDR report key: 1760680 · Received July 14, 2010

    Report

    Report Number
    1523530-2010-00003
    Event Type
    Malfunction
    Date Received
    July 14, 2010
    Date of Event
    June 18, 2010
    Report Date
    July 14, 2010
    Manufacturer
    MIDMARK CORP.
    Product Code
    EAZ
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    THE SUSPENSION TUBE FROM THE MONITOR TROLLEY FELL. NO ONE WAS HURT. THE DOCTOR AND THE PATIENT CAUGHT THE FLEX ARM AND SUSPENSION TUBE AS IT FELL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MIDMARK LIGHT, OPERATING, DENTAL EAZ MIDMARK CORP. 029-4739-00

    Patients

    Seq Age Sex Outcome Treatment
    1