BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    STORZ

    MDR report key: 372561 · Received January 23, 2002

    Report

    Report Number
    372561
    Event Type
    Malfunction
    Date Received
    January 23, 2002
    Date of Event
    November 14, 2001
    Report Date
    November 26, 2001
    Manufacturer
    *
    Product Code
    BWH
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    GRASPER FORCEPS TIP FROM RIGID BRONCHOSCOPE BROKE INSIDE ESOPHAGUS WITH DIRECT VISION SCOPE SURGEON RETRIEVEL TIP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 STORZ GRASPER FOR RIGID BRONCHOSCOPE BWH * 10377H *

    Patients

    Seq Age Sex Outcome Treatment
    1 3 YR Other