BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    OVERHEAD COUNTERPOISE SYSTEM

    MDR report key: 230757 · Received July 1, 1999

    Report

    Report Number
    2520313-1999-00023
    Event Type
    Malfunction
    Date Received
    July 1, 1999
    Date of Event
    May 26, 1999
    Report Date
    June 30, 1999
    Manufacturer
    F. WALTER HANEL GMBH
    Product Code
    DXT
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    ME, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    HOSP REPORTED THE FLANGE ON THE CEILING MOUNT BROKE. THE "AC" POWER CORD KEPT IT 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