BEUDAMED
    FDA Adverse Event Other Summary report: N

    LIGHT SOURCE

    MDR report key: 32207 · Received March 19, 1996

    Report

    Report Number
    32207
    Event Type
    Other
    Date Received
    March 19, 1996
    Date of Event
    March 7, 1996
    Report Date
    March 8, 1996
    Manufacturer
    STORZ INSTRUMENT CO.
    Product Code
    FCW
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    NJ, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    DR COMPLETED PROCEDURE AND PLACED LIGHT CORD ON PT DRAPE. LIGHT TURNED OFF BY NURSE. ON REMOVAL OF DRAPE A 1 1/2 CM (DIME SIZE) BLISTER WAS NOTED. THERE WAS A BURN NOTED IN DRAPE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIGHT SOURCE LIGHT CORD FCW STORZ INSTRUMENT CO. 9175, 495NB

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Other