BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    12.4CM HEAVY DUT LONG ATTCH

    MDR report key: 3042670 · Received April 2, 2013

    Report

    Report Number
    1045834-2013-01155
    Event Type
    Malfunction
    Date Received
    April 2, 2013
    Date of Event
    August 2, 2011
    Report Date
    August 2, 2011
    Manufacturer
    THE ANSPACH EFFORT, INC.
    Product Code
    HBE
    PMA / PMN Number
    K042783
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE WAS RECEIVED BY ANSPACH. IF ADDITIONAL INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SENT. REF: (B)(4).

    Description of Event or Problem · 1

    THE REPORT RECEIVED FROM THE USA STATING THAT THE DEVICE WAS "OVERHEATING{. THE DEVICE WAS 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
    134407 12.4CM HEAVY DUT LONG ATTCH HBE THE ANSPACH EFFORT, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1