BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AUTOSONIX ULTRA SHEARS SHORT

    MDR report key: 2133246 · Received May 11, 2011

    Report

    Report Number
    1219930-2011-00369
    Event Type
    Malfunction
    Date Received
    May 11, 2011
    Date of Event
    April 14, 2011
    Report Date
    April 14, 2011
    Manufacturer
    UNITED STATES SURGICAL
    Product Code
    LFL
    PMA / PMN Number
    K971861
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    ACCORDING TO THE REPORTER: DURING THE CASE, THE TIP OF THE ACTIVE BLADE WAS BROKEN. NOTHING FELL INTO THE PATIENT'S CAVITY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AUTOSONIX ULTRA SHEARS SHORT DISPOSABLE SURGICAL DEVICE LFL UNITED STATES SURGICAL

    Patients

    Seq Age Sex Outcome Treatment
    1