BEUDAMED
    FDA Adverse Event Other Summary report: N

    KARL STORZ

    MDR report key: 371161 · Received January 10, 2002

    Report

    Report Number
    2020550-2001-00032
    Event Type
    Other
    Date Received
    January 10, 2002
    Date of Event
    April 20, 2001
    Report Date
    January 8, 2002
    Manufacturer
    KARL STORZ GMBH & CO. KG
    Product Code
    FBJ
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    CA
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE CO WAS CONTACTED BY PT'S ATTORNEY WHO REPORTED THAT "A FIRE BROKE OUT ON THE OPERATING TABLE DURING THE USE OF A HYSTEROSCOPE AND RESECTOSCOPE." AFTER CONTACTING HOSP, THE CO WAS TOLD THAT A HIGH FREQUENCY CORD WAS BLOWN FROM THE CONNECTOR AND A SPARK MADE CONTACT WITH INCONTINENCE PAD. PAD CAUGHT ON FIRE CAUSING INJURIES TO THE PT. PROCEDURE CANCELLED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KARL STORZ HIGH FREQUENCY CORD FBJ KARL STORZ GMBH & CO. KG 277KB CK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other