BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    OLYMPUS

    MDR report key: 285433 · Received July 7, 2000

    Report

    Report Number
    285433
    Event Type
    Malfunction
    Date Received
    July 7, 2000
    Date of Event
    June 2, 2000
    Report Date
    June 6, 2000
    Manufacturer
    *
    Product Code
    HCZ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    IL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DURING A HYSTERECTEROSCOPY, WHILE ATTEMPTING TO REMOVE AN INTRAUTERINE DEVICE, THE JAWS OF THE GRASPER BROKE. HALF OF THE JAW WAS RETRIEVED AND HALF WAS NOT. PHYSICIAN MADE AWARE OF SITUATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OLYMPUS GRASPER A4695 HCZ * * *

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR