BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GU BOVIE CORD

    MDR report key: 3594515 · Received January 10, 2014

    Report

    Report Number
    3594515
    Event Type
    Malfunction
    Date Received
    January 10, 2014
    Date of Event
    December 20, 2013
    Report Date
    January 10, 2014
    Manufacturer
    WILL PROVIDE
    Product Code
    GEI
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US

    Narratives

    Description of Event or Problem · 1

    GU SURGICAL PENCIL STARTED SMOKING WHERE CORD AND INSTRUMENT FORCEPS MEET. THEN BROKE OFF. REPLACED INSTRUMENT; NO HARM TO PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    20592 GU BOVIE CORD CORD, ELECTRIC, FOR ENDOSCOPE GEI WILL PROVIDE * *
    20593 GU BOVIE FORCEP FORCEPS, GENERAL & PLASTIC SURGERY GEN WILL PROVIDE * *
    20594 ARGON BEAM ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES GEI WILL PROVIDE * *

    Patients

    Seq Age Sex Outcome Treatment
    1 24 YR