BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MAVIG GMBH

    MDR report key: 2119748 · Received June 3, 2011

    Report

    Report Number
    MW5020913
    Event Type
    Injury
    Date Received
    June 3, 2011
    Manufacturer
    MAVIG GMBH
    Product Code
    JAA
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ARM BROKE OFF OF THE COLUMN AND HIT THE TECHNICIAN IN THE BACK OF THE HEAD CAUSING A SMALL HEMATOMA. WE ARE WORKING ON GETTING THIS ARM BACK SO IT CAN BE TESTED. DATES OF USE: ABOUT 6 YEARS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MAVIG GMBH HANEL ARM JAA MAVIG GMBH 0T25U50
    2 MAVIG GMBH HANEL ARM JAA MAVIG GMBH

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization