BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AUGOLUBE - III W/FOOT CONTROL

    MDR report key: 3043034 · Received March 7, 2013

    Report

    Report Number
    1045834-2013-00581
    Event Type
    Malfunction
    Date Received
    March 7, 2013
    Date of Event
    February 8, 2011
    Report Date
    February 8, 2011
    Manufacturer
    THE ANSPACH EFFORT, INC.
    Product Code
    GEY
    PMA / PMN Number
    K970530
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE WAS RECEIVED BY ANSPACH. IF ADD'L INFO IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SENT. (B)(4).

    Description of Event or Problem · 1

    REPORT RECEIVED FROM THE USA STATING THAT THE DEVICE WAS "MAKING A HISSING SOUND AND WAS ALSO LEAKING OIL." THE DEVICE WAS NOT BEING USED DURING A PROCEDURE. NO PATIENT OR USER INJURES WERE REPORTED. THERE WAS NO ADD'L INFO PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    98475 AUGOLUBE - III W/FOOT CONTROL GEY THE ANSPACH EFFORT, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1