BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    OLYMPUS SNARE MASTER

    MDR report key: 2150748 · Received June 29, 2011

    Report

    Report Number
    MW5021228
    Event Type
    Malfunction
    Date Received
    June 29, 2011
    Date of Event
    June 23, 2011
    Report Date
    June 29, 2011
    Manufacturer
    OLYMPUS
    Product Code
    FDI
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PT UNDERGOING A COLONOSCOPY AND POLYPECTOMY. DISPOSABLE ELECTROSURGICAL SNARE DID NOT DELIVER CURRENT TO THE SITE AND DID NOT CUT THROUGH THE POLYP. IT WAS REMOVED AND PROCEDURE COMPLETED WITH ANOTHER DEVICE. NO HARM TO THE PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OLYMPUS SNARE MASTER SNARE FDI OLYMPUS SD-2300-20 12K

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR