BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 371597 · Received January 14, 2002

    Report

    Report Number
    371597
    Event Type
    Malfunction
    Date Received
    January 14, 2002
    Date of Event
    November 16, 2001
    Report Date
    November 30, 2001
    Manufacturer
    CODMAN & SHURTLEFF, INC.
    Product Code
    FFO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    BOOK WALTER ATTACHMENT BROKE OFF FROM RETACTOR WHILE INSTRUMENT BEING USED. ALL PIECES RETRIEVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * BOOKWALTER TILTER RATCHET MECHANISM FFO CODMAN & SHURTLEFF, INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR