BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GREENLIGHT ADDSTAT

    MDR report key: 1920750 · Received December 9, 2010

    Report

    Report Number
    2937094-2010-01231
    Event Type
    Malfunction
    Date Received
    December 9, 2010
    Date of Event
    November 3, 2010
    Report Date
    November 11, 2010
    Manufacturer
    AMS, INNOVATION CTR - SILICON VALLEY
    Product Code
    GEX
    PMA / PMN Number
    K062719
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED BY THE CUSTOMER THAT ON (B)(6) 2010, THE AIMING BEAM FIRED STRAIGHT OUT OF THE FIBER AT 16,761 JOULES. NO PT INJURY WAS REPORTED. THE DEVICE WAS NOT RETURNED FOR EVAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GREENLIGHT ADDSTAT SURGICAL FIBER GEX AMS, INNOVATION CTR - SILICON VALLEY NA 021H

    Patients

    Seq Age Sex Outcome Treatment
    1 Other