BEUDAMED
    FDA Adverse Event Other Summary report: N

    OVERHEAD COUNTERPOISE SYSTEM

    MDR report key: 216518 · Received March 25, 1999

    Report

    Report Number
    2520313-1999-00014
    Event Type
    Other
    Date Received
    March 25, 1999
    Date of Event
    February 16, 1999
    Manufacturer
    F. WALTER HANEL GMBH
    Product Code
    DXT
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE PLASTIC THAT HOLDS THE BRASS RETAINING CLIP HAD CRACKED AND CAME OFF, THE BRASS CLIP CAME OUT AND THE VERTICAL ARM HIT THE TABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OVERHEAD COUNTERPOISE SYSTEM OVERHEAD COUNTERPOISE SYSTEM DXT F. WALTER HANEL GMBH OCS115 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Other