BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DORMIA STONE BASKET 4W W/O FILIFORM TIP

    MDR report key: 22959 · Received May 24, 1995

    Report

    Report Number
    2429473-1995-00013
    Event Type
    Malfunction
    Date Received
    May 24, 1995
    Date of Event
    April 4, 1995
    Report Date
    May 23, 1995
    Manufacturer
    PORGES S.A. CENTRE D'AFFAIRES LA BOURSIDIERE
    Product Code
    FFL
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THERE IS A PART MISSING THAT ALLOWS THE BASKET TO RETRACT BACK INTO THE SHEATH. RETURNED TO MFR FOR EVALUATION ON 5/1/95.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DORMIA STONE BASKET 4W W/O FILIFORM TIP STONE BASKET FFL PORGES S.A. CENTRE D'AFFAIRES LA BOURSIDIERE 920101

    Patients

    Seq Age Sex Outcome Treatment
    1 *