BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    QUANTA SYSTEM S.P.A.

    MDR report key: 3232325 · Received December 21, 2012

    Report

    Report Number
    3004378299-2012-00014
    Event Type
    Malfunction
    Date Received
    December 21, 2012
    Date of Event
    June 11, 2012
    Report Date
    December 19, 2012
    Manufacturer
    QUANTA SYSTEM, S.P.A.
    Product Code
    GEX
    PMA / PMN Number
    K090962
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    THE ROD WAS BROKEN, PROBABLY FOR DEFECTED CRYSTAL. WE ARE UNAWARE ABOUT PT INJURY.

    Description of Event or Problem · 1

    LASER SYSTEM PRODUCED NO ENERGY OUTPUT. WE ARE UNAWARE ABOUT PT INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUANTA SYSTEM S.P.A. SURGICAL LASER GEX QUANTA SYSTEM, S.P.A. CYBER TM 120

    Patients

    Seq Age Sex Outcome Treatment
    1