BEUDAMED
    FDA Adverse Event Other Summary report: N

    MICROVASIVE

    MDR report key: 385464 · Received March 27, 2002

    Report

    Report Number
    385464
    Event Type
    Other
    Date Received
    March 27, 2002
    Date of Event
    March 2, 2002
    Report Date
    March 27, 2002
    Manufacturer
    MICROVASIVE
    Product Code
    KNS
    Report Source
    User Facility report
    Reporter Location
    GA, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    GOLD PROBE WITH INJECTION NEEDLE DEPLOYED FROM END OF ENDOSCOPE, ENTIRE GOLD PROBE AND "BLACK WASHER" DEPLOYED OFF OF THE PROBE INTO PT. ANOTHER PROBE (GOLD 7 FR WITH INJ) USED, WOULD NOT RETACT BACK. ENTIRE SCOPE WITH PROBE REMOVED AND PACKAGING RETAINED. NO HARM TO PT. WILL PASS THROUGH GI TRACT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MICROVASIVE GOLDEN PROBE KNS MICROVASIVE UPNM00560150 4479621
    2 MICROVASIVE GOLDEN PROBE KNS MICROVASIVE UPNM00560150 3867717

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Other