BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HOLMIUM LASER

    MDR report key: 2941006 · Received October 19, 2006

    Report

    Report Number
    2941006
    Event Type
    Malfunction
    Date Received
    October 19, 2006
    Date of Event
    October 10, 2006
    Report Date
    October 17, 2006
    Manufacturer
    CONVERGENT LASER TECHNICIAN
    Product Code
    GEX
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DURING REMOVED OF REUSED STONES, LASER STOPPED WORKING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOLMIUM LASER LASER FIBER OPTASITE GEX CONVERGENT LASER TECHNICIAN SMH/040F

    Patients

    Seq Age Sex Outcome Treatment
    1 39 YR