BEUDAMED
    FDA Adverse Event Injury Summary report: N

    "SURCH-LITE"

    MDR report key: 405937 · Received July 17, 2002

    Report

    Report Number
    405937
    Event Type
    Injury
    Date Received
    July 17, 2002
    Date of Event
    June 24, 2002
    Report Date
    July 12, 2002
    Manufacturer
    AARON MEDICAL INDUSTRIES
    Product Code
    FTF
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    WI, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    LIGHT BULB AND HOLDER SEPARATED FROM DEVICE USED BY ANESTHESIA. BRONCHOSCOPY DONE TO REMOVE THE METAL TIP OF THE "SURCH-LITE" FROM THE MAIN STEM BRONCHUS OF RIGHT LUNG.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 "SURCH-LITE" 15" NON-STERILE FLEXIBLE LIGHT FTF AARON MEDICAL INDUSTRIES NS15 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 41 YR Required Intervention