BEUDAMED
    FDA Adverse Event Other Summary report: N

    ANGENIEUX

    MDR report key: 421613 · Received October 9, 2002

    Report

    Report Number
    9710053-2002-00001
    Event Type
    Other
    Date Received
    October 9, 2002
    Date of Event
    August 15, 2002
    Report Date
    October 4, 2002
    Manufacturer
    ALM
    Product Code
    FSY
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE MAIN ARM OF THE LIGHT ASSEMBLY DISCONNECTED FROM THE SUSPENSION TUBE, ALLOWING THE LIGHTING SYSTEM TO FALL. UPON FALLING, THE MAIN ARM STRUCK THE DOCTOR IN THE SHOULDER. THE EXTEND OF THEIR INJURY WAS NOT REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ANGENIEUX SURGICAL LIGHT FSY ALM AX4S NA

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR