BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TAKAHASHI NASAL FORCEPS

    MDR report key: 2550902 · Received April 19, 2012

    Report

    Report Number
    2550902
    Event Type
    Malfunction
    Date Received
    April 19, 2012
    Date of Event
    April 12, 2012
    Report Date
    April 19, 2012
    Manufacturer
    STORZ INSTRUMENTS
    Product Code
    JXX
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    KY, US

    Narratives

    Description of Event or Problem · 1

    PATIENT WAS UNDERGOING A FUNCTIONAL ENDOSCOPIC SINUS SURGERY AND SEPTOPLASTY. PHYSICIAN WAS USING TAKAHASHI FORCEPS. HE HAD THE FORCEPS IN THE NOSE, PREPARING TO REMOVE SOME TISSUE, WHEN THE TOP OF THE BLADE BROKE OFF IN THE NOSE. PIECES WERE REMOVED AND THERE WAS NO HARM TO PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TAKAHASHI NASAL FORCEPS FORCEPS, NASAL JXX STORZ INSTRUMENTS * *

    Patients

    Seq Age Sex Outcome Treatment
    1 17 YR