BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GREENLIGHT MOXY

    MDR report key: 2180889 · Received July 7, 2011

    Report

    Report Number
    2937094-2011-01443
    Event Type
    Malfunction
    Date Received
    July 7, 2011
    Date of Event
    May 26, 2011
    Report Date
    June 20, 2011
    Manufacturer
    AMS, INNOVATION CENTER-SILICON VALLEY
    Product Code
    GEX
    PMA / PMN Number
    K100746
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED BY A CUSTOMER ON (B)(6) 2011 THE FIBER CAP DETACHED AT 84,569 JOULES. PER THE CUSTOMER, THE FIBER CAP WAS RETRIEVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GREENLIGHT MOXY SURGICAL FIBER GEX AMS, INNOVATION CENTER-SILICON VALLEY NA 104A

    Patients

    Seq Age Sex Outcome Treatment
    1 Other