BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HAENE CLAMP

    MDR report key: 2994393 · Received March 1, 2013

    Report

    Report Number
    MW5029251
    Event Type
    Injury
    Date Received
    March 1, 2013
    Date of Event
    March 1, 2013
    Report Date
    March 1, 2013
    Manufacturer
    V. MULLER INSTRUMENTS -CARE FUSION-
    Product Code
    HCZ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    TIP OF HAENE CLAMP BROKE OFF IN THE PT'S VAGINAL DURING SURGICAL INTERVENTION. THE TIP WAS RETRIEVED. DIAGNOSIS OR REASON FOR USE: TOTAL VAGINAL HYSTERECTOMY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    89542 HAENE CLAMP HAENE CLAMP HCZ V. MULLER INSTRUMENTS -CARE FUSION- GL 3100 GL 3100

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR Required Intervention