BEUDAMED
    FDA Adverse Event Other Summary report: N

    OVERHEAD COUNTERPOISE SYSTEM

    MDR report key: 238407 · Received August 16, 1999

    Report

    Report Number
    2520313-1999-00025
    Event Type
    Other
    Date Received
    August 16, 1999
    Date of Event
    June 18, 1999
    Manufacturer
    F. WALTER HANEL, GMBH
    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

    WHILE A HANEL COUTERPOISE SYSTEM WAS BEING ADJUSTED, THE COUNTERPOISE HIT THE CEILING CAUSING THE MEDRAD INJECTOR HEAD TO DETACH FROM THE COUNTERPOISE SYSTEM. THE INJECTOR HEAD FELL AND HIT THE TECHNICIAN.

    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