BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GLIDESCOPE GVL 5

    MDR report key: 2974043 · Received February 19, 2013

    Report

    Report Number
    9615393-2013-00094
    Event Type
    Malfunction
    Date Received
    February 19, 2013
    Date of Event
    January 21, 2013
    Report Date
    January 21, 2013
    Manufacturer
    VERATHON MEDICAL (CANADA) ULC
    Product Code
    CCW
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    SERVICE RECEIVED THE DEVICE FOR FURTHER EVALUATION. SERVICE CONFIRMED THE REPORTED INCIDENT. A REPLACEMENT DEVICE WAS SENT TO THE CUSTOMER .

    Description of Event or Problem · 1

    THE CUSTOMER CONTACTED VERATHON INC. IN REGARDS TO A GLIDESCOPE GVL 5 BLADE THAT HAS A BROKEN CONNECTOR PORT. THE DEVICE WAS RETURNED TO FURTHER INVESTIGATION. NO INJURY TO PATIENT WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    72438 GLIDESCOPE GVL 5 NONE CCW VERATHON MEDICAL (CANADA) ULC 0574-0030

    Patients

    Seq Age Sex Outcome Treatment
    1