BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CUTOM - MEDIUM ATTACH WITH EXT. TAP

    MDR report key: 3042437 · Received April 3, 2013

    Report

    Report Number
    1045834-2013-01260
    Event Type
    Malfunction
    Date Received
    April 3, 2013
    Date of Event
    November 1, 2011
    Report Date
    November 28, 2011
    Manufacturer
    THE ANSPACH EFFORT, INC.
    Product Code
    HBC
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

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

    Description of Event or Problem · 1

    THE REPORT RECEIVED FROM (B)(4) STATING THAT THE DEVICE WAS "HEATING, THE COLOR BAND AND BEARING CAME OFF." THE DEVICE WAS NOT BEING USED IN SURGERY. THERE WAS NO REPORTED PT OR USER INJURIES. THERE WAS NO ADDITIONAL INFORMATION PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    135876 CUTOM - MEDIUM ATTACH WITH EXT. TAP HBC THE ANSPACH EFFORT, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1