BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    STORZ LEIVERS MOUTH GAG FRAM-CHILD SIZE RIGHT

    MDR report key: 43007 · Received October 17, 1996

    Report

    Report Number
    1932180-1996-00090
    Event Type
    Malfunction
    Date Received
    October 17, 1996
    Date of Event
    September 17, 1996
    Report Date
    September 17, 1996
    Manufacturer
    STORZ INSTRUMENT COMPANY
    Product Code
    KBN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    THE THUMB LEVER ON THE MOUTH GAG WAS FOUND TO BE BROKEN WHEN THE PHYSICIAN ATTEMPTED TO INSERT IT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 STORZ LEIVERS MOUTH GAG FRAM-CHILD SIZE RIGHT MOUTH GAG KBN STORZ INSTRUMENT COMPANY NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO