BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    5MM, 33CM PEEK MONOPOLAR HANDLE 33CM

    MDR report key: 2945125 · Received December 27, 2012

    Report

    Report Number
    2936485-2012-00602
    Event Type
    Malfunction
    Date Received
    December 27, 2012
    Date of Event
    December 4, 2012
    Report Date
    December 4, 2012
    Manufacturer
    STRYKER ENDOSCOPY SAN JOSE
    Product Code
    KOG
    PMA / PMN Number
    K973259
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    ADD'L INFO WILL BE PROVIDED ONCE THE INVESTIGATION HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    BREAK IN THE INSULATION. PO#: B008065.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 5MM, 33CM PEEK MONOPOLAR HANDLE 33CM KOG STRYKER ENDOSCOPY SAN JOSE 1147153D

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK