BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    4MM A/C CANNULA, 2 ROTATING STOPCOCKS W/SPEEDLOCK

    MDR report key: 2133208 · Received May 9, 2011

    Report

    Report Number
    2936485-2011-00298
    Event Type
    Malfunction
    Date Received
    May 9, 2011
    Date of Event
    April 4, 2011
    Report Date
    April 11, 2011
    Manufacturer
    STRYKER ENDOSCOPY SAN JOSE
    Product Code
    DWF
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    ADDITIONAL INFO WILL BE PROVIDED ONCE THE INVESTIGATION IS COMPLETED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THERE WERE RUST SPOTS AROUND THE SCREW HOLES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 4MM A/C CANNULA, 2 ROTATING STOPCOCKS W/SPEEDLOCK CANNULA DWF STRYKER ENDOSCOPY SAN JOSE 1063501

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK