BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GREENLIGHT ADDSTAT

    MDR report key: 2090773 · Received April 26, 2011

    Report

    Report Number
    2937094-2011-00785
    Event Type
    Malfunction
    Date Received
    April 26, 2011
    Date of Event
    January 26, 2011
    Report Date
    April 5, 2011
    Manufacturer
    AMS INNOVATIVE CENTER-SILICON VALLEY
    Product Code
    GEX
    PMA / PMN Number
    K062719
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED BY A CUSTOMER ON (B)(6) 2011 THE FIBER FORWARD FIRED AND/OR THE FIBER WAS DAMAGED AT THE TIP AT 21,799 JOULES. NO PT INJURY WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GREENLIGHT ADDSTAT SURGICAL FIBER GEX AMS INNOVATIVE CENTER-SILICON VALLEY NA 035H

    Patients

    Seq Age Sex Outcome Treatment
    1 Other