BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    OVERHEAD COUNTERPOISE SYSTEM

    MDR report key: 223738 · Received May 14, 1999

    Report

    Report Number
    2520313-1999-00020
    Event Type
    Malfunction
    Date Received
    May 14, 1999
    Date of Event
    March 29, 1999
    Report Date
    May 14, 1999
    Manufacturer
    F. WALTER HANEL, GMBH
    Product Code
    DXT
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE VERTICAL ARM SEPARATED FROM THE HORIZONTAL ARM OF THE OVERHEAD COUNTERPOISE SYSTEM. THE CABLE KEPT THE ARM FROM HITTING THE FLOOR. NO INJURY OCCURRED.

    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