FDA Adverse Event
Injury
Summary report: N
JACOBSON MOSQUITO FORCEPS
MDR report key: 20915562
·
Received December 11, 2024
Report
- Report Number
- MW5163555
- Event Type
- Injury
- Date Received
- December 11, 2024
- Report Date
- December 9, 2024
- Manufacturer
- HERMANN MUELLER MEDIZINTECHNIK GMBH
- Product Code
- DWS
- Product Problem
- Yes
- Report Source
- Voluntary report
- Reporter Occupation
- 003
- Health Professional
- *
Narratives
Description of Event or Problem · 0
METAL TIP FROM JACOBSEN CLAMP BROKE OFF DURING SURGICAL CASE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 2377010 | JACOBSON MOSQUITO FORCEPS | INSTRUMENTS, SURGICAL, CARDIOVASCULAR | DWS | HERMANN MUELLER MEDIZINTECHNIK GMBH | CH 8610 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | NA | Unknown | Required Intervention |