BEUDAMED
    FDA Adverse Event Other Summary report: N

    OVERHEAD COUNTERPOISE SYSTEM

    MDR report key: 216667 · Received March 26, 1999

    Report

    Report Number
    2520313-1999-00013
    Event Type
    Other
    Date Received
    March 26, 1999
    Date of Event
    February 15, 1999
    Report Date
    March 26, 1999
    Manufacturer
    F. WALTER HANEL GMGH
    Product Code
    DXT
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE PIN ON THE YOKE BROKE CAUSING THE OVERHEAD COUNTERPOISE SYSTEM AND THE HEAD TO FALL. NO ONE WAS INJURED.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Other