BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DOUBLE SPOON FORCEP FOR SINUSCOPY

    MDR report key: 25346 · Received July 18, 1994

    Report

    Report Number
    1418479-1994-09083
    Event Type
    Malfunction
    Date Received
    July 18, 1994
    Report Date
    June 29, 1994
    Manufacturer
    R. WOLF, GMBH
    Product Code
    KAE
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    NO
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    PER WRITTEN NOTICE FROM OUR PARENT CO., THE ABOVE CAPTIONED INSTRUMENT WAS RECEIVED AT THEIR FACILITY FOR INSPECTION. BOTH JAWS ON THE INSTRUMNET WERE MISSING. NO FURHTER INFORMATION IS AVAILABLE.INVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: UNKNOWN. INVALID DATA - REGARDING MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: NONE OR UNKNOWN. RESULTS OF EVALUATION: NONE OR UNKNOWN. CONCLUSION: NONE OR UNKNOWN. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: NONE OR UNKNOWN. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DOUBLE SPOON FORCEP FOR SINUSCOPY SAME KAE R. WOLF, GMBH 8211.188 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Other