BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PERMASORB

    MDR report key: 2875113 · Received December 5, 2012

    Report

    Report Number
    2875113
    Event Type
    Malfunction
    Date Received
    December 5, 2012
    Date of Event
    September 19, 2012
    Report Date
    December 5, 2012
    Manufacturer
    C.R. BARD, INC
    Product Code
    KOG
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NJ, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    TACKS JAMMED AT THE TIP OF THE HANDPIECE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PERMASORB ENDOSCOPE AND/OR ACCESSORIES KOG C.R. BARD, INC * CVWD0602

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR