BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SYSTEM CONSOLE, SINGLE PORT, W/ IRRIGATION

    MDR report key: 2934324 · Received January 11, 2013

    Report

    Report Number
    1045834-2013-00082
    Event Type
    Malfunction
    Date Received
    January 11, 2013
    Date of Event
    December 1, 2012
    Report Date
    December 14, 2012
    Manufacturer
    THE ANSPACH EFFORT, INC.
    Product Code
    HBC
    PMA / PMN Number
    K080802
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE HAS BEEN RECEIVED BY ANSPACH. IF ADDITIONAL INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SENT.

    Description of Event or Problem · 1

    REPORT RECEIVED FROM THE USE STATING THAT THE "FOOT PEDAL PLUG IN FRONT HAD PULLED OUT AND THE WIRES WERE EXPOSED." THE DEVICE WAS NOT BEING SUED DURING SURGERY, IT WAS FOUND DURING ROUTINE INSPECTION. THERE WERE NO INJURIES OR MEDICAL INTERVENTION REPORTED. THERE WAS NO ADDITIONAL INFORMATION PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    19128 SYSTEM CONSOLE, SINGLE PORT, W/ IRRIGATION HBC THE ANSPACH EFFORT, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1